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 Apr 20;10(4):e0123215. doi: 10.1371/journal.pone.0123215. eCollection 2015.

Abstract

Aim: To compare the prognostic accuracy of six scoring models for up to three-year mortality and rates of hospitalisation due to acute decompensated heart failure (ADHF) in STEMI patients.

Methods and results: A total of 593 patients treated with primary PCI were evaluated. Prospective follow-up of patients was ≥3 years. Thirty-day, one-year, two-year, and three-year mortality rates were 4.0%, 7.3%, 8.9%, and 10.6%, respectively. Six risk scores--the TIMI score and derived dynamic TIMI, CADILLAC, PAMI, Zwolle, and GRACE--showed a high predictive accuracy for six- and 12-month mortality with area under the receiver operating characteristic curve (AUC) values of 0.73-0.85. The best predictive values for long-term mortality were obtained by GRACE. The next best-performing scores were CADILLAC, Zwolle, and Dynamic TIMI. All risk scores had a lower prediction accuracy for repeat hospitalisation due to ADHF, except Zwolle with the discriminatory capacity for hospitalisation up to two years (AUC, 0.80-0.83).

Conclusions: All tested models showed a high predictive value for the estimation of one-year mortality, but GRACE appears to be the most suitable for the prediction for a longer follow-up period. The tested models exhibited an ability to predict the risk of ADHF, especially the Zwolle model.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Models, Biological
  • Multivariate Analysis
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / mortality*
  • Patient Discharge
  • Predictive Value of Tests
  • Risk Factors
  • Time Factors
  • Ultrasonography

Grants and funding

This work was supported by the MH CZ - DRO (FNBr, 65269705), by the European Regional Development Fund – Project FNUSA-ICRC (CZ.1.05/1.1.00/02.0123), the Grant of Ministry of Education Youth and Sports of the Czech Republic (MUNI/A/1012/2013). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.