Comparisons on the long-term predictive values of different risk scoring systems for the major adverse cardiovascular events among the middle-elderly acute coronary syndrome patients
Objective To compare the predictive values of thrombolysis in myocardial infarction(TIMI),global registration of acute coronary events(GRACE)and Korean registry for acute myocardial infarction risk(KAMIR)scores on the occurrences of major adverse cardiovascular events(MACE)within one year after the hospitalization among the patients with different types of middle-elderly acute coronary syndrome(ACS).Methods Clinical data of 415 middle-elderly subjects were obtained in the department of Cardiology from the Affiliated Hospital of Chengde Medical College from January 2020 to April 2022.According to their clinical diagnosis,they were subsumed into three different subgroups,such as ST segment elevation myocardial infarction(STEMI),non-ST segment elevation myocardial infarction(NSTEMI)and unstable angina pectoris(UAP).Their TIMI,GRACE,and KAMIR risk scores at the admission were calculated.Then their incidences of MACE were recorded within one year of follow-up.The correlations between the risk scores(TIMI,GRACE,and KAMIR)and occurrences of MACE among the STEMI,NSTEMI and UAP subgroups were analyzed.Meanwhile,the area under the receiver operating characteris-tic(ROC)curve(AUC)was used to evaluate the predictive values of TIMI,GRACE,and KAMIR on the accuracy of MACE.Results Among the 415 middle-elderly ACS subjects,113 were STEMI,70 were NSTEMI,and 232 were UAP.Their incidences of MACE were respectively 30.09％,31.43％,and 32.76％within one year of follow-up.Moreover,it was found that there were positive correlations between the TIMI(r=0.644,0.665,0.578,P＜0.001),GRACE(r=0.718,0.798,0.719,P＜0.001)and KAMIR risk scores(r=0.579,0.623,0.582,P＜0.001)with MACE score through Spearman correlation analysis among the STEMI,NSTEMI and UAP groups re-spectively(P＜0.05).The ROC curve showed that the AUC of GRACE risk score was significantly higher than that of TIMI and KAMIR risk scores among both the STEMI and NSTEMI patients[AUC(95％CI):STEMI,0.835(0.809-0.861),0.764(0.741-0.787),0.731(0.686-0.776);NSTEMI,0.848(0.797-0.899),0.725(0.703-0.748),0.713(0.670-0.759),P＜0.05],while the AUC of GRACE risk score was also higher than TIMI risk score in the UAP patients[AUC(95％CI):0.783(0.726-0.841),0.711(0.667-0.755),P＜0.05],and there was no statistical difference between the GRACE and KAMIR risk scores[AUC(95％CI):0.783(0.726-0.841),0.736(0.696-0.776),P＞0.05].However,there were no differences in the AUC of TIMI and KAMIR risk scores among all these three subgroups(P＞0.05).Conclusions The TIMI,GRACE and KAMIR risk scores are all related with the occurrence of MACE within one year after the hospitalization among the middle-elderly ACS patients,which can serve as a reference for their future therapeutic schedule.However,GRACE risk score is prioritized for the STEMI and NSTEMI patients,and KAMIR is better for UAP in view of their practicability.
acute coronary syndromethrombolysis in myocardial infarctionglobal registration of acute coro-nary eventsKorean registry for acute myocardial infarctionrisk scoresmajor adverse cardiac events
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