Abstract 3581: Predicting Mortality in Acute Coronary Syndromes; A Comparison of the TIMI and GRACE Risk Scores

Abstract

Background: The Thrombolysis In Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores are widely recognized tools for assessing risk in patients with acute coronary syndromes (ACS). However, their relative predictive abilities remain poorly defined in broad-spectrum ACS populations. Objective: We sought to compare the effectiveness of the GRACE and TIMI risk scores in predicting in-hospital and 6-month post-discharge mortality in unselected patients presenting with ACS. Methods: Data were collected for 3451 patients admitted to the University of Michigan between 1999 and 2005 with an admission diagnosis of ACS. Six month follow-up data were available for 3170 of these patients. GRACE and TIMI scores were calculated for each patient based on previously established criteria. The predictive ability of each score was assessed for two primary outcomes - in-hospital mortality and 6-month mortality - by analyzing the area under each receiver operating characteristic (ROC) curve. Results: The observed mortality was 3.97% (137 deaths) in-hospital and 7.38% (234 deaths) at 6 months among those surviving to hospital discharge. The GRACE score was significantly better than the TIMI score in predicting in hospital and 6-month mortality (p<0.0001 in both cases, Figure ). Conclusion: The GRACE score was significantly better than the TIMI score in predicting in-hospital and 6-month mortality in unselected patients presenting with ACS.