Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 3, June 2021, pages 177-185

The Difference in Accuracy Between Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score in Predicting In-Hospital Mortality of Acute ST-Elevation Myocardial Infarction Patients

Figure 1. AUC of GRACE and TIMI scores in one plot ROC. GRACE: Global Registry of Acute Coronary Events; TIMI: Thrombolysis in Myocardial Infarction; AUC: area under the curve; ROC: receiver operator characteristic.

**Table 1.** Patients Baseline Characteristics
Variables	Total (n = 255)
Age (years)	58 ± 11
Male, n (%)	201 (78.8)
Previous history, n (%)
Diabetes mellitus	55 (21.6)
Hypertension	144 (56.5)
Angina	56 (22.0)
Smoking	167 (65.5)
Dyslipidemia	99 (61.0)
Family history of myocardial infarction	17 (6.7)
Menopause	32 (12.5)
Coronary artery bypass grafting	1 (0.4)
Percutaneous coronary intervention	13 (5.1)
Myocardial infarction	31 (12.2)
Heart failure	28 (11.0)
Stroke	19 (7.5)
Delay
First medical contact (h)	3 (0 - 240)
Onset to Dr. Hasan Sadikin Hospital (h)	10 (0.5 - 336)
Onset to reperfusion (h)	9.5 (0.1 - 216)
Transfer time (h)	6 (0 - 142)
Onset to reperfusion, n (%)
> 4 h	215 (84.3)
≤ 4 h	40 (15.7)
Onset percutaneous coronary intervention (h)	24 (1 - 230)
Onset percutaneous coronary intervention, n (%)
< 12 h	41 (27.0)
12 - 24 h	42 (27.6)
> 24 h	69 (45.4)
Door to needle (min)	60 (6 - 541)
Door to device (min)	563 (13 - 12,960)
In-hospital treatment, n (%)
Medication use, n (%)
Dual anti-platelet	251(98.4)
Angiotensin-converting enzyme inhibitor	148 (58.0)
Beta-blocker	141 (55.3)
Statin	241 (94.5)
Anticoagulant	244 (95.7)
Reperfusion method, n (%)
Fibrinolytic	67 (26.3)
Percutaneous coronary intervention	101 (39.6)
Non-reperfusion	87 (34.1)
Length of stay (days)	4 (0 - 19)

Table 1. Patients Baseline Characteristics

Variables

Total (n = 255)

Age (years)

58 ± 11

Male, n (%)

201 (78.8)

Previous history, n (%)

Diabetes mellitus

55 (21.6)

Hypertension

144 (56.5)

Angina

56 (22.0)

Smoking

167 (65.5)

Dyslipidemia

99 (61.0)

Family history of myocardial infarction

17 (6.7)

Menopause

32 (12.5)

Coronary artery bypass grafting

1 (0.4)

Percutaneous coronary intervention

13 (5.1)

Myocardial infarction

31 (12.2)

Heart failure

28 (11.0)

Stroke

19 (7.5)

Delay

First medical contact (h)

3 (0 - 240)

Onset to Dr. Hasan Sadikin Hospital (h)

10 (0.5 - 336)

Onset to reperfusion (h)

9.5 (0.1 - 216)

Transfer time (h)

6 (0 - 142)

Onset to reperfusion, n (%)

> 4 h

215 (84.3)

≤ 4 h

40 (15.7)

Onset percutaneous coronary intervention (h)

24 (1 - 230)

Onset percutaneous coronary intervention, n (%)

< 12 h

41 (27.0)

12 - 24 h

42 (27.6)

> 24 h

69 (45.4)

Door to needle (min)

60 (6 - 541)

Door to device (min)

563 (13 - 12,960)

In-hospital treatment, n (%)

Medication use, n (%)

Dual anti-platelet

251(98.4)

Angiotensin-converting enzyme inhibitor

148 (58.0)

Beta-blocker

141 (55.3)

Statin

241 (94.5)

Anticoagulant

244 (95.7)

Reperfusion method, n (%)

Fibrinolytic

67 (26.3)

Percutaneous coronary intervention

101 (39.6)

Non-reperfusion

87 (34.1)

Length of stay (days)

4 (0 - 19)

**Table 2.** Baseline Characteristics of GRACE and TIMI Variables
Variables	Total (n = 255)	Death (n = 45)	Survive (n = 210)	P
^at-test. ^bMann-Whitney test. ^cChi-square test. ^dFisher’s exact test. *P < 0.05. GRACE: Global Registry of Acute Coronary Events; TIMI: Thrombolysis in Myocardial Infarction; LBBB: left bundle branch block.
Common variables in GRACE and TIMI scores
Age (years)	58 ± 11	63 ± 12	57 ± 10	< 0.001^a*
Age category, n (%)
< 65 years	188 (73.7)	25 (55.6)	163 (77.7)	0.002^c*
65 - 75 years	54 (21.2)	14 (31.1)	40 (19.0)
> 75 years	13 (5.1)	6 (13.3)	7 (3.3)
Systolic arterial pressure (mm Hg)	120 (60 - 209)	100 (60 - 190)	120 (70 - 209)	< 0.001^b*
Systolic category, n (%)
< 90	22 (8.6)	14 (30.4)	8 (3.8)	< 0.001^c*
90 - 139	176 (68.7)	26 (56.5)	150 (71.4)
140 - 159	36 (14.1)	3 (6.6)	33 (15.8)
160 - 180	16 (6.3)	1 (2.2)	15 (7.1)
> 180	6 (2.3)	2 (4.3)	4 (1.9)
Heart rate (bpm)	82 (30 - 188)	96 (32 - 140)	80 (30 - 188)	< 0.001^b*
Heart rate category, n (%)
< 60	23 (9.0)	5 (11.1)	18 (8.6)	< 0.001^c*
60 - 100	193 (75.7)	22 (48.9)	171 (81.4)
> 100	39 (15.3)	18 (40.0)	21 (10.0)
Killip, n (%)
I	185 (72.5)	16 (35.6)	169 (80.5)	< 0.001^c*
II	31 (12.2)	5 (11.1)	26 (12.4)
III	9 (3.5)	6 (13.3)	3 (1.4)
IV	30 (11.8)	18 (40.0)	12 (5.7)
Variable exclusive to GRACE score
Cardiac arrest, n (%)	37 (14.5)	31 (68.9)	6 (2.9)	< 0.001^c*
Troponin (mg/dL)	10.0 (0.01 - 10.0)	10.0 (0.01 - 10.0)	10.0 (0.01 - 10.0)	0.591^b
Creatinine (mg/dL)	1.16 (0.49 - 15.30)	1.18 (0.72 - 7.70)	1.15 (0.49 - 15.30)	0.414^b
ST-segment deviation (%)	255 (100)	45 (100)	210 (100)	-
Variable exclusive to TIMI
Weight (kg)	55 (43 - 114)	50 (45 - 114)	55 (43 - 103)	0.140^b
Risk factors
DM	55 (21.6)	14 (31.1)	41 (19.5)	0.086^c
Hypertension	144 (56.5)	27 (60.0)	117 (55.7)	0.599^c
Angina	56 (22.0)	9 (20.0)	47 (22.4)	0.726^c
Time to treatment > 4 h	215 (84.3)	40 (88.9)	175 (83.3)	0.352^d
Anterior/LBBB	128 (50.2)	22 (48.9)	106 (50.4)	0.088^c

Table 2. Baseline Characteristics of GRACE and TIMI Variables

Variables

Total (n = 255)

Death (n = 45)

Survive (n = 210)

^at-test. ^bMann-Whitney test. ^cChi-square test. ^dFisher’s exact test. *P < 0.05. GRACE: Global Registry of Acute Coronary Events; TIMI: Thrombolysis in Myocardial Infarction; LBBB: left bundle branch block.

Common variables in GRACE and TIMI scores

Age (years)

58 ± 11

63 ± 12

57 ± 10

< 0.001^a*

Age category, n (%)

< 65 years

188 (73.7)

25 (55.6)

163 (77.7)

0.002^c*

65 - 75 years

54 (21.2)

14 (31.1)

40 (19.0)

> 75 years

13 (5.1)

6 (13.3)

7 (3.3)

Systolic arterial pressure (mm Hg)

120 (60 - 209)

100 (60 - 190)

120 (70 - 209)

< 0.001^b*

Systolic category, n (%)

< 90

22 (8.6)

14 (30.4)

8 (3.8)

< 0.001^c*

90 - 139

176 (68.7)

26 (56.5)

150 (71.4)

140 - 159

36 (14.1)

3 (6.6)

33 (15.8)

160 - 180

16 (6.3)

1 (2.2)

15 (7.1)

> 180

6 (2.3)

2 (4.3)

4 (1.9)

Heart rate (bpm)

82 (30 - 188)

96 (32 - 140)

80 (30 - 188)

< 0.001^b*

Heart rate category, n (%)

< 60

23 (9.0)

5 (11.1)

18 (8.6)

< 0.001^c*

60 - 100

193 (75.7)

22 (48.9)

171 (81.4)

> 100

39 (15.3)

18 (40.0)

21 (10.0)

Killip, n (%)

185 (72.5)

16 (35.6)

169 (80.5)

< 0.001^c*

31 (12.2)

5 (11.1)

26 (12.4)

III

9 (3.5)

6 (13.3)

3 (1.4)

30 (11.8)

18 (40.0)

12 (5.7)

Variable exclusive to GRACE score

Cardiac arrest, n (%)

37 (14.5)

31 (68.9)

6 (2.9)

< 0.001^c*

Troponin (mg/dL)

10.0 (0.01 - 10.0)

0.591^b

Creatinine (mg/dL)

1.16 (0.49 - 15.30)

1.18 (0.72 - 7.70)

1.15 (0.49 - 15.30)

0.414^b

ST-segment deviation (%)

255 (100)

45 (100)

210 (100)

Variable exclusive to TIMI

Weight (kg)

55 (43 - 114)

50 (45 - 114)

55 (43 - 103)

0.140^b

Risk factors

55 (21.6)

14 (31.1)

41 (19.5)

0.086^c

Hypertension

144 (56.5)

27 (60.0)

117 (55.7)

0.599^c

Angina

56 (22.0)

9 (20.0)

47 (22.4)

0.726^c

Time to treatment > 4 h

215 (84.3)

40 (88.9)

175 (83.3)

0.352^d

Anterior/LBBB

128 (50.2)

22 (48.9)

106 (50.4)

0.088^c

**Table 3.** Comparison of Accuracy GRACE and TIMI Scores
Risk scores	TIMI	GRACE	ΔAUC	P
^aFisher’s z-test. CI: confidence interval; GRACE: Global Registry of Acute Coronary Events; TIMI: Thrombolysis in Myocardial Infarction; AUC: area under the curve.
AUC (95% CI)	0.835 (0.784 - 0.878)	0.917 (0.877 - 0.948)	0.082 (0.040 - 0.125)	< 0.001^a

Table 3. Comparison of Accuracy GRACE and TIMI Scores

Risk scores

TIMI

GRACE

ΔAUC

^aFisher’s z-test. CI: confidence interval; GRACE: Global Registry of Acute Coronary Events; TIMI: Thrombolysis in Myocardial Infarction; AUC: area under the curve.

AUC (95% CI)

0.835 (0.784 - 0.878)

0.917 (0.877 - 0.948)

0.082 (0.040 - 0.125)

< 0.001^a