Evaluation of Global Registry of Acute Cardiac Events and Thrombolysis in Myocardial Infarction scores in patients with suspected acute coronary syndrome - 21/11/11
, Mike Bradburn, MSc a, 1, Abdikudus Mohamed, MB, ChB a, 1, Alasdair Gray, MB, ChB b, 1Abstract |
Purposes |
We aimed to evaluate the Global Registry of Acute Cardiac Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in patients with suspected but not proven acute coronary syndrome (ACS).
Basic procedures |
We conducted a secondary analysis of data from the RATPAC trial. Standardized data were collected from 2263 patients presenting to 6 emergency departments with suspected but not proven ACS. Patients were followed up by record review and postal questionnaire at 30 and 90 days after recruitment to identify major adverse events, defined as death, emergency revascularization, life-threatening arrhythmia, hospitalization for ACS, or nonfatal acute myocardial infarction (AMI).
Main findings |
Data were available for 2243 patients (mean age, 54.5 years; 58% male). The major adverse event rate was 43 (2%) of 2243 after 30 days and 62 (3%) of 2243 after 90 days. The c statistics for 30-day events were 0.717 (95% confidence interval [CI], 0.698-0.735) for GRACE and 0.682 (95% CI, 0.662-0.701) for TIMI. The corresponding 90-day c statistics were 0.726 (95% CI, 0.707-0.745) for GRACE and 0.693 (95% CI, 0.674-0.712) for TIMI. The c statistic for patient age alone was 0.656 for 30-day events and 0.689 for 90-day events.
Principal conclusions |
The GRACE and TIMI scores are little better than age alone as predictors of major adverse events in patients with suspected but not proven ACS, and thus add little to prognostic assessment of such patients.
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| ☆ | Funding sources: The RATPAC trial was funded by the United Kingdom National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (no. 06/302/19). The study funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The researchers were independent of the study funders. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR HTA. |
| ☆☆ | Prior presentations: none. |
| ★ | The RATPAC Research Team: Charlotte Arrowsmith (RATPAC Research Nurse, Derriford Hospital, Plymouth); Julian Barth (Consultant in Chemical Pathology, Leeds General Infirmary/Co-applicant); Jonathan Benger (Professor of Emergency Care, University of the West of England/Co-applicant); Mike Bradburn (Senior Medical Statistician, Clinical Trials Research Unit, University of Sheffield); Simon Capewell (Professor of Epidemiology, University of Liverpool/Co-applicant); Tim Chater (Database Manager, Clinical Trials Research Unit, University of Sheffield); Tim Coats (Professor of Emergency Medicine/Co-applicant); Paul Collinson (Consultant in Chemical Pathology, St George's Hospital, London/Co-applicant); Cindy Cooper (Director, Clinical Trials Research Unit, University of Sheffield); Mandy Cooper (RATPAC Research Nurse, Leicester Royal Infirmary); Judy Coyle (RATPAC Research Nurse, Edinburgh Royal Infirmary); Liz Cross (Trial Manager, Health Services Research, University of Sheffield); Simon Dixon (Professor of Health Economics, Health Economics & Decision Science/Co-applicant); Patrick Fitzgerald (Research Fellow, Health Economics & Decision Science, University of Sheffield); Emma Gendall (RATPAC Research Nurse, Frenchay Hospital, Bristol); Steve Goodacre (Professor of Emergency Medicine, Health Services Research, University of Sheffield/Chief Investigator); Emma Goodwin (RATPAC Research Nurse, Barnsley Hospital); Alasdair Gray (Consultant in Emergency Medicine, Royal Infirmary of Edinburgh/Co-applicant); Alistair Hall (Professor of Clinical Cardiology, University of Leeds/Co-applicant); Kevin Hall (RATPAC Research Nurse, Barnsley Hospital); Taj Hassan (Consultant in Emergency Medicine, Leeds General Infirmary/Co-applicant); Julian Humphrey (Consultant in Emergency Medicine, Barnsley Hospital); Steven Julious (Senior Lecturer in Medical Statistics, Medical Statistics Group, Health Services Research, University of Sheffield/Co-applicant); Jason Kendall (Consultant in Emergency Medicine, Frenchay Hospital, Bristol); Vanessa Lawlor (RATPAC Research Nurse, Frenchay Hospital, Bristol); Sue Mackness (RATPAC Research Nurse, Leicester Royal Infirmary); Yvonne Meades (RATPAC Research Nurse, Leeds General Infirmary); David Newby (Professor of Cardiology, University of Edinburgh/Co-applicant); Dawn Newell (RATPAC Research Nurse, Leicester Royal Infirmary); Doris Quartey (RATPAC Research Nurse, Leeds General Infirmary); Karen Robinson (RATPAC Research Nurse, Leicester Royal Infirmary); Glen Sibbick (RATPAC Research Nurse, Leicester Royal Infirmary); Jason Smith (Consultant in Emergency Medicine, Derriford Hospital, Plymouth); Roz Squire (RATPAC Research Nurse, Derriford Hospital, Plymouth). |
Vol 30 - N° 1
P. 37-44 - janvier 2012 Retour au numéro
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