Comparative Prognostic Value Of GRACE、TIMI And PURSUIT Risk Scores In Patients With Acute Coronary Syndrome

Background：Acute coronary syndrome(ACS) is the emergency department of coronary heartdisease, which often leads to massive myocardial infarction and even sudden death,with varying risks of early adverse events, requiring a diverse range of clinicalstrategies, so it needs to undertake the risk score to those patients. We often used theindividual clinical indicators, such as angina characteristics, ECG ST-segmentchanges, myocardial injury markers and other indicators of changes to assess theprognosis of ACS patients, although these individual variables had some clinicalvalues to the risk score and prognosis assessment, but they aren’t comprehensiveenough. Multiple clinical indicators after simultaneously correction of multi-factoranalysis of the results, can more accurate to risk stratification and predict theprognosis to ACS patients, such as Global Registry Of Acute CoronaryEvents(GRACE) risk score, The Thrombolysis In Myocardial Infarction(TIMI) riskscore, The Platelet glycoprotein Ⅱb/Ⅲa in Unstable angina: Receptor SuppressionUsing Integrilin Therapy trial(PURSUIT) risk score and so on, but which risk scorehas good predictive value, and how to choose, it is not clear, and rare of reports in thisarea.Objectives：This article was aimed to assess the short-term prognosis of the ACS patients bythe simple GRACE, TIMI and PURSUIT risk scores，explored which risk score hadgreater predictive value, so that it can provide some references for clinicians to choosewhich risk score for predicting short-term prognosis.Methods：Retrospectively analyzed the clinical data of278patients with acute coronarysyndrome in the cardiology department of our hospital from January,2011to February, 2012, average age：63.7±11.9years,21.9%with female,32.7%with UA,18.0%withNSTEMI,49.3%with STEMI. We followed up the occurrence of MACE and deathduring hospitalization. The independent risk factors for major adverse cardiovascularevents were evaluated by means of multivariate logistic regression analysis amongbaseline clinical characteristics and laboratory data. For each patient, GRACE, TIMIand PURSUIT risk scores were calculated by the clinical variables on admission, andcalculated the MACE rate and mortality for each risk score group, differences ofabove parameters were compared. We described the ROC curve for three risk scoresand computed the areas under the curves(AUC).The predictive value of three riskscores for MACE rate and mortality in-hospital were measured by the area under theROC curve.Results：1.The incidences of MACE rate was26.9%in-hospital，the incidences ofmotality was2.5%in-hospital.2.Multivariate logistic regression analysis implied elevation of age(P=0.000,OR=0.886), increased of B-tye Natriuretic Peptide(P=0.011, OR=0.998), increased ofN-terminal pro-B-type Natriuretic Peptide(P=0.000, OR=0.996), elevation of WhiteBlood Cell Count(P=0.002, OR=0.816), increased of serum creatinine(P=0.000,OR=0.078) were all associated with an increase in major adverse cardiovascularevents in-hospital, and they were respectively independent risk factor of the increaseof major adverse cardiovascular events.3.The MACE rate and motality were trend of increased with GRACE, TIMI andPURSUIT risk score. The incidence rate of MACE among the patients in-hospital ofall groups for GRACE, TIMI and PURSUIT risk scores have significant differences(P=0.000,0.006,0.003), the incidence rate of death among three groups of TIMI riskscore have significant differences (P=0.011), but incidence rate of death among allgroups of GRACE and PURSUIT risk scores have not significant differences(P=0.188,0.171).4.GRACE, TIMI and PURSUIT risk scores all demonstrated good predictivevalue for in-hospital MACE(AUC=0.663,0.642,0.596, respectively all P<0.05)anddeath(AUC=0.882,0.790,0.785, respectively all P<0.05).The best predictive valuefor MACE rate and motality were obtained by the GRACE risk score, but thepredictive value of the PURSUIT, and TIMI risk scores were also good. Conclusion：1.Elevation of age, increased of B-tye Natriuretic Peptide, increased ofN-terminal pro-B-type Natriuretic Peptide, elevation of White Blood Cell Count,increased of serum creatinine are independent risk factors for patients with ACS.2.The value of GRACE，TIMI and PURSUIT risk scores predicted in-hospitalMACE and death in patients with acute coronary syndrome manifests good, they allcan use in clinical.3.GRACE risk score presented the best predictive value, GRACE risk score canbe used as the first choice in our clinical work.