The Validation and Comparison of Zwolle, TIMI, and GRACE Risk Scores for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention in The Indonesian Population.
Keywords:
Risk score, major adverse cardiovascular events, primary percutaneous coronary interventions
Abstract
Background
Zwolle, TIMI, and GRACE risk scores have been proven to predict mayor adverse cardiovascular events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, they were developed over a long time ago which many advances have been made in the cardiovascular field today. The scores were also developed in the non-Asian majority population and their accuracy for Indonesian population remains unknown. We aimed to validate and compare these scores for Indonesian population.
Methods
An analytical observational study was conducted on 193 patients undergoing primary PCI. The Zwolle, GRACE, and TIMI risk scores were calculated for each patient. Then, the risk score validation was carried out with the calibration test using Hosmer Lemeshow test and discrimination test using the AUC ROC. Furthermore, the comparisons between the risk scores were carried out using the DeLong test.
Results
The three scores have good results in the Hosmer Lemeshow calibration test (p > 0.05). The discrimination test also indicated good results with AUC ROC Zwolle, TIMI and GRACE risk scores respectively 0.776; 0.782; 0.831 (p<0.05). There was no significant difference in the prediction accuracy of the three risk scores in the DeLong test.
Conclusions
The Zwolle, TIMI, and GRACE risk scores had good validity for predicting major adverse cardiovascular events in STEMI patients undergoing primary PCI. There was no significant difference in the prediction accuracy of the three risk scores.
Keywords: Risk score, major adverse cardiovascular events, primary percutaneous coronary interventions
Downloads
Download data is not yet available.
References
1. Ahmed N, Carberry J, Teng V, Carrick D, Berry C. Risk assessment in patients with an acute ST-elevation myocardial infarction. Eff Res. 2016;5(6):581-593.
2. Boer M De, Hoorntje JCA, Dambrink JE, Timi P. Prognostic Assessment of Patients With Acute Myocardial Infarction Treated With Primary Angioplasty. Circulation. 2004:2737-2743.
3. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, De Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II trial substudy. Circulation. 2000;102(17):2031-2037.
4. Braunwald E, Neuhaus KL, Antman E, Chew P, Skene A, Wilcox R, et al. Intravenous NPA for the treatment of infarcting myocardium early: InTIME-II, a double-blind comparison on of single-bolus lanoteplase vs accelerated alteplase for the treatment of patients with acute myocardial infarction. Eur Heart J. 2000;21(24):2005-2013.
5. Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). Bmj. 2006;333(7578):1091-1091.
6. Granger CB. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003;163(19):2345.
7. Wynants L, Collins GS, Van Calster B. Key steps and common pitfalls in developing and validating risk models. BJOG An Int J Obstet Gynaecol. 2017;124(3):423-432.
8. Damen JAAG, Hooft L, Schuit E, Debray TPA, Collins GS, Tzoulaki I, et al. Prediction models for cardiovascular disease risk in the general population: Systematic review. BMJ. 2016;353.
9. Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, et al. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017;136(20):1908-1919.
10. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: The CADILLAC risk score. J Am Coll Cardiol. 2005;45(9):1397-1405.
11. Stebbins A, Mehta RH, Armstrong PW, Lee KL, Hamm C, Van De Werf F, et al. A model for predicting mortality in acute st-segment elevation myocardial infarction treated with primary percutaneous coronary intervention : Results from the assessment of pexelizumab in acute myocardial infarction trial. Circ Cardiovasc Interv. 2010;3(5):414-422.
12. Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44(8):1553-1602.
13. Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-1316.
14. Littnerova S, Kala P, Jarkovsky J, Kubkova L, Prymusova K, Kubena P, et al. GRACE score among six risk scoring systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) demonstrated the best predictive value for prediction of long-term mortality in patients with ST-elevation myocardial infarction. PLoS One. 2015;10(4):1-15.
15. Abelin AP, David RB, Gottschall CA, Quadros AS. Accuracy of Dedicated Risk Scores in Patients Undergoing Primary Percutaneous Coronary Intervention in Daily Clinical Practice. Can J Cardiol. 2014;30(1):125-131.
16. Peng Y, Du X, Rogers KD, Wu Y, Gao R, Patel A. Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China. Am J Cardiol. 2017;120(7):1077-1083.
17. Chan MY, Shah BR, Gao F, Sim LL, Chua T, Tan HC, et al. Recalibration of the Global Registry of Acute Coronary Events risk score in a multiethnic Asian population. Am Heart J. 2011;162(2):291-299.
18. Selvarajah S, Fong AYY, Selvaraj G, Haniff J, Uiterwaal CSPM, Bots ML. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction. PLoS One. 2012;7(7):1-7.
19. Koonsiripaiboon E, Tungsubutra W. Validation of the GRACE risk score to predict in-hospital mortality in patients with ST segment elevation myocardial infarction in Thailand. J Med Assoc Thail. 2013;96(SUPPL2):139-145.
20. Prabhudesai AR, Srilakshmi MA, Santosh MJ, Shetty GG, Varghese K, Patil CB, et al. Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes. Indian Heart J. 2012;64(3):263-269.
21. Kozieradzka A, Kamiński KA, Maciorkowska D, Olszewska M, Dobrzycki S, Nowak K, et al. GRACE, TIMI, Zwolle and CADILLAC risk scores - Do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively? Int J Cardiol. 2011;148(1):70-75.
22. van der Schaaf RJ, Timmer JR, Ottervanger JP, Hoorntje JC a, de Boer M-J, Suryapranata H, et al. Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy. Heart. 2006;92(12):1760-1763.
23. Westerhout CM, Pieper KS, James SK, Mahaffey KW. Acute Ischemic Heart Disease Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J. 165(3):354-362.e2.
24. Kim D-W, Her S-H, Park M-W, Cho JS, Kim T-S, Kang H, et al. Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. Int Heart J. 2017;58(5):674-685.
25. Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, et al. Clinical and Angiographic Correlates and Outcomes of Suboptimal Coronary Flow in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol. 2003;42(10):1739-1746.
2. Boer M De, Hoorntje JCA, Dambrink JE, Timi P. Prognostic Assessment of Patients With Acute Myocardial Infarction Treated With Primary Angioplasty. Circulation. 2004:2737-2743.
3. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, De Lemos JA, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An Intravenous nPA for Treatment of Infarcting Myocardium Early II trial substudy. Circulation. 2000;102(17):2031-2037.
4. Braunwald E, Neuhaus KL, Antman E, Chew P, Skene A, Wilcox R, et al. Intravenous NPA for the treatment of infarcting myocardium early: InTIME-II, a double-blind comparison on of single-bolus lanoteplase vs accelerated alteplase for the treatment of patients with acute myocardial infarction. Eur Heart J. 2000;21(24):2005-2013.
5. Fox KAA, Dabbous OH, Goldberg RJ, Pieper KS, Eagle KA, Van de Werf F, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). Bmj. 2006;333(7578):1091-1091.
6. Granger CB. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. Arch Intern Med. 2003;163(19):2345.
7. Wynants L, Collins GS, Van Calster B. Key steps and common pitfalls in developing and validating risk models. BJOG An Int J Obstet Gynaecol. 2017;124(3):423-432.
8. Damen JAAG, Hooft L, Schuit E, Debray TPA, Collins GS, Tzoulaki I, et al. Prediction models for cardiovascular disease risk in the general population: Systematic review. BMJ. 2016;353.
9. Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, et al. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017;136(20):1908-1919.
10. Halkin A, Singh M, Nikolsky E, Grines CL, Tcheng JE, Garcia E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: The CADILLAC risk score. J Am Coll Cardiol. 2005;45(9):1397-1405.
11. Stebbins A, Mehta RH, Armstrong PW, Lee KL, Hamm C, Van De Werf F, et al. A model for predicting mortality in acute st-segment elevation myocardial infarction treated with primary percutaneous coronary intervention : Results from the assessment of pexelizumab in acute myocardial infarction trial. Circ Cardiovasc Interv. 2010;3(5):414-422.
12. Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, et al. ICU admission, discharge, and triage guidelines: A framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44(8):1553-1602.
13. Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-1316.
14. Littnerova S, Kala P, Jarkovsky J, Kubkova L, Prymusova K, Kubena P, et al. GRACE score among six risk scoring systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) demonstrated the best predictive value for prediction of long-term mortality in patients with ST-elevation myocardial infarction. PLoS One. 2015;10(4):1-15.
15. Abelin AP, David RB, Gottschall CA, Quadros AS. Accuracy of Dedicated Risk Scores in Patients Undergoing Primary Percutaneous Coronary Intervention in Daily Clinical Practice. Can J Cardiol. 2014;30(1):125-131.
16. Peng Y, Du X, Rogers KD, Wu Y, Gao R, Patel A. Predicting In-Hospital Mortality in Patients With Acute Coronary Syndrome in China. Am J Cardiol. 2017;120(7):1077-1083.
17. Chan MY, Shah BR, Gao F, Sim LL, Chua T, Tan HC, et al. Recalibration of the Global Registry of Acute Coronary Events risk score in a multiethnic Asian population. Am Heart J. 2011;162(2):291-299.
18. Selvarajah S, Fong AYY, Selvaraj G, Haniff J, Uiterwaal CSPM, Bots ML. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction. PLoS One. 2012;7(7):1-7.
19. Koonsiripaiboon E, Tungsubutra W. Validation of the GRACE risk score to predict in-hospital mortality in patients with ST segment elevation myocardial infarction in Thailand. J Med Assoc Thail. 2013;96(SUPPL2):139-145.
20. Prabhudesai AR, Srilakshmi MA, Santosh MJ, Shetty GG, Varghese K, Patil CB, et al. Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes. Indian Heart J. 2012;64(3):263-269.
21. Kozieradzka A, Kamiński KA, Maciorkowska D, Olszewska M, Dobrzycki S, Nowak K, et al. GRACE, TIMI, Zwolle and CADILLAC risk scores - Do they predict 5-year outcomes after ST-elevation myocardial infarction treated invasively? Int J Cardiol. 2011;148(1):70-75.
22. van der Schaaf RJ, Timmer JR, Ottervanger JP, Hoorntje JC a, de Boer M-J, Suryapranata H, et al. Long-term impact of multivessel disease on cause-specific mortality after ST elevation myocardial infarction treated with reperfusion therapy. Heart. 2006;92(12):1760-1763.
23. Westerhout CM, Pieper KS, James SK, Mahaffey KW. Acute Ischemic Heart Disease Dynamic modeling of 90-day mortality in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Am Heart J. 165(3):354-362.e2.
24. Kim D-W, Her S-H, Park M-W, Cho JS, Kim T-S, Kang H, et al. Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction. Int Heart J. 2017;58(5):674-685.
25. Mehta RH, Harjai KJ, Cox D, Stone GW, Brodie B, Boura J, et al. Clinical and Angiographic Correlates and Outcomes of Suboptimal Coronary Flow in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol. 2003;42(10):1739-1746.
Published
2022-06-30
Views & Downloads
Abstract views: 1313
Full Text (PDF) downloads: 817
Full Text (PDF) downloads: 817
How to Cite
Asrial, A., & Pudjiastuti, A. (2022). The Validation and Comparison of Zwolle, TIMI, and GRACE Risk Scores for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention in The Indonesian Population. Indonesian Journal of Cardiology, 43(2), 56-63. https://doi.org/10.30701/ijc.1324
Section
Clinical Research
Copyright (c) 2023 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
