TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: A meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients
TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: A meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients
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DOI：
10.1016/j.cct.2012.01.001
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发表时间：
2012-05-01
影响因子：
2.2
通讯作者：
Gaita, Fiorenzo
中科院分区：
文献类型：
--
作者：
D'Ascenzo, Fabrizio;Biondi-Zoccai, Giuseppe;Gaita, Fiorenzo
背景：急性冠状动脉综合征（ACS）对医生来说是一个艰巨的挑战。风险评分已成为临床和介入决策的基石。方法和结果：系统地检索了 PubMed 中的 ACS 风险评分研究。它们被分为 ACS 研究（评估不稳定型心绞痛；UA、非 ST 段抬高型心肌梗死；NSTEMI 和 ST 段抬高型心肌梗死；STEMI）、UA/NSTEMI 研究或 STEMI 研究。在适当的情况下使用随机效应方法汇总验证研究的 c 统计量。对 7 项涉及 25,525 名 ACS 患者的衍生研究和 15 项涉及 257,654 人的验证研究进行了正式评估。短期（0.82；0.80-0.89 I.C 95%）和长期随访（0.84；0.82-0.87；I.C 95%）的 GRACE 评分汇总分析均显示出最佳表现，与短期简单风险指数 (SRI) 推导队列的结果相似。对于 NSTEMI/UA。纳入了 18 项衍生研究（涉及 56,560 名患者）和 18 项验证队列（涉及 56,673 名患者）。验证研究的汇总分析显示，短期和长期 TIMI 验证研究的 c 统计量分别为 0.54 (95% Cl = 0.52-0.57) 和 0.67 (95% Cl = 0.62-0.71)，而 TIMI 验证研究的 c 统计量分别为 0.83 (95% Cl = 0.79-9.87) 和 0.80 (95% Cl = 0.74-0.89)。短期和长期 GRACE 研究。对于 STEMI，15 项涉及 734,557 名患者的推导评分研究和 17 项涉及 187,619 名患者的验证研究显示，短期和长期 TIMI 的汇总 c 统计量分别为 0.77 (95% Cl = 0.71-0.83) 和 0.77 (95% Cl = 0.72-0.85)，汇总 c 统计量为GRACE 的短期和长期风险评分分别为 0.82 (95% Cl = 0.81-0.83) 和 0.81(95% Cl = 0.80-0.82)。结论：TIMI 和 GRACE 是迄今为止研究最广泛的风险评分，其中 GRACE 表现更好。还有其他可能有用的 ACS 风险评分，但这些评分尚未经过严格验证。这项研究表明，这些其他分数可能具有潜在的用途，应该进一步研究。 (C) 2012 Elsevier Inc. 保留所有权利。
Background: Acute coronary syndromes (ACS) represent a difficult challenge for physicians. Risk scores have become the cornerstone in clinical and interventional decision making.Methods and results: PubMed was systematically searched for ACS risk score studies. They were divided into ACS studies (evaluating Unstable Angina; UA, Non ST Segment Elevation Myocardial Infarction; NSTEMI, and ST Segment Elevation Myocardial Infarction; STEMI), UA/NSTEMI studies or STEMI studies. The c-statistics of validation studies were pooled when appropriate with random-effect methods. 7 derivation studies with 25,525 ACS patients and 15 validation studies including 257,654 people were formally appraised. Pooled analysis of GRACE scores, both at short (0.82; 0.80-0.89 I.C 95%) and long term follow up (0.84; 0.82-0.87; I.C 95%) showed the best performance, with similar results to Simple Risk Index (SRI) derivation cohorts at short term. For NSTEMI/UA. 18 derivation studies with 56,560 patients and 18 validation cohorts with 56,673 patients were included. Pooled analysis of validations studies showed c-statistics of 0.54 (95% Cl = 0.52-0.57) and 0.67 (95% Cl = 0.62-0.71) for short and long term TIMI validation studies, and 0.83 (95% Cl = 0.79-9.87) and 0.80 (95% Cl = 0.74-0.89) for short and long term GRACE studies. For STEMI, 15 studies with 734,557 patients with derivation scores, and 17 validation studies with 187,619 patients showed a pooled c-statistic of 0.77 (95% Cl = 0.71-0.83) and 0.77 (95% Cl = 0.72-0.85) for TIMI at short and long term, and a pooled c-statistic of 0.82 (95% Cl = 0.81-0.83) and 0.81(95% Cl = 0.80-0.82) for GRACE at short and long terms respectively.Conclusions: TIMI and GRACE are the risk scores that up until now have been most extensively investigated, with GRACE performing better. There are other potentially useful ACS risk scores available however these have not undergone rigorous validation. This study suggests that these other scores may be potentially useful and should be further researched. (C) 2012 Elsevier Inc. All rights reserved.