The Anatolian Journal of Cardiology

Akut koroner sendrom hastalarında koroner arter hastalığı yaygınlığı ve ciddiyetini öngörmede GRACE risk skoru ve TIMI risk indeksinin karşılaştırılması [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(10): 801-806 | DOI: 10.5152/akd.2014.5802  

Akut koroner sendrom hastalarında koroner arter hastalığı yaygınlığı ve ciddiyetini öngörmede GRACE risk skoru ve TIMI risk indeksinin karşılaştırılması

Adem Bekler1, Burak Altun1, Emine Gazi1, Ahmet Temiz1, Ahmet Barutçu1, Ömer Güngör2, Muhammed Turgut Alper Özkan3, Sedat Özcan1, Sabri Gazi2, Bahadır Kırılmaz1
1Department of Cardiology, Çanakkale Onsekiz Mart University, Faculty of Medicine; Çanakkale-Turkey
2Department of Cardiology, Çanakkale State Hospital; Çanakkale-Turkey
3Department of Cardiovascular Surgery, Çanakkale Onsekiz Mart University, Faculty of Medicine; Çanakkale-Turkey

Amaç: Akut koroner olayların global kayıtlı (GRACE) risk skoru (GRS) ve miyokart enfarktüsünde tromboliz (TIMI) risk indeksinin (TRI) koroner arter hastalığı (KAH) hastalarındaki prognostik değeri daha önce gösterilmiştir. Biz akut koroner sendrom (AKS) hastalarında GRS ve TRI ile SYNTAX skoru (SS) ile değerlendirilen KAH ciddiyeti arasındaki ilişkiyi değerlendirmeyi amaçladık. Yöntemler: Çalışmaya toplam 287 AKS [154 ST elevasyonu olmayan AKS (NSTE-AKS) ve 133 ST elevasyonu olan miyokart enfarktüsü (STEMI)] hastası alındı. GRS ve TRI ile ilgili skorlar başvurudaki spesifik değişkenlerle hesaplandı. KAH ciddiyeti SS ile değerlendirildi. Hastalar GRS' na göre düşük (GRS<109), orta risk (109-140) ve yüksek risk (GRS>140) ve TRI'ne göre grup 1 (TRI<17), grup 2 (TRI 17-26) ve grup 3 (TRI>26) olarak 3 gruba ayrıldı. GRS, TRI ve SS arasındaki ilişki için Pearson korelasyon analizi uygulandı. Bulgular: Tüm hastalarda risk gruplarında ortalama yaş (p<0,001), kalp hızı (p<0,001), SS (p<0,001), TRI (p<0,001), NSTE-AKS oranı (p<0,001) ve STEMI oranı (p<0,001) anlamlı farklıydı. GRS ile SS (r=0,427, p<0,001) arasında anlamlı pozitif korelasyon vardı, fakat TRI ile SS arasında anlamlı korelasyon yoktu (r=0,121, p=0,135). KAH ciddiyeti öngörüsünde GRS için ROC eğrisi altında kalan alan 0,65 (%95 CI: 0,56-0.74, p=0,001) idi. Sonuç: AKS hastalarında KAH ciddiyetini öngörmede GRS, TRI'ne göre SS ile daha fazla ilişkilidir.

Anahtar Kelimeler: akut koroner sendrom, GRACE risk skoru, TIMI risk indeksi, SYNTAX skoru.


Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome

Adem Bekler1, Burak Altun1, Emine Gazi1, Ahmet Temiz1, Ahmet Barutçu1, Ömer Güngör2, Muhammed Turgut Alper Özkan3, Sedat Özcan1, Sabri Gazi2, Bahadır Kırılmaz1
1Department of Cardiology, Çanakkale Onsekiz Mart University, Faculty of Medicine; Çanakkale-Turkey
2Department of Cardiology, Çanakkale State Hospital; Çanakkale-Turkey
3Department of Cardiovascular Surgery, Çanakkale Onsekiz Mart University, Faculty of Medicine; Çanakkale-Turkey

Objective: The prognostic value of the Global Registry of Acute Coronary Events (GRACE) risk score (GRS) and the Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) has been reported in coronary artery disease (CAD) patients. We aimed to evaluate the relationship between the GRS, TRI, and severity of CAD evaluated by SYNTAX score (SS) in patients with acute coronary syndrome (ACS). Methods: Patients with ACS who were admitted to the coronary care unit of our institution were retrospectively evaluated in this study. A total of 287 patients with ACS [154 non-ST elevated ACS (NSTE-ACS), 133 ST elevated myocardial infarction (STEMI)] were included in the study. The GRS and TRI were calculated on admission using specified variables. The severity of CAD was evaluated using the SS. The patients were divided into low (GRS<109)-, intermediate (GRS 109-140)-, and high (GRS>140)-risk groups and group 1 (TRI<17), group 2 (TRI 17-26), and group 3 (TRI>26) according to GRS and TRI scores. A Pearson correlation analysis was used for the relation between GRS, TRI, and SS. Results: Patients with a history of coronary artery bypass surgery, those who had missing data for calculating the GRS and TRI, and those whose systolic blood pressure (SBP) was more than 180 mm Hg or whose diastolic blood pressure (DBP) was more than 110 mm Hg were excluded from the study. Were excluded from the study. There were significant differences in mean age (p<0.001), heart rate (p<0.001), SS (p<0.001), TRI (p<0.001), rate of NSTE-ACS (p<0.001), and STEMI (p<0.001) in all patients between the risk groups. There was a positive significant correlation between the GRS and the SS (r=0.427, p<0.001), but there were no significant correlation between the TRI and SS (r=0.121, p=0.135). The area under the ROC curve value for GRS was 0.65 (95% CI: 0.56-0.74, p=0.001) in the prediction of severity of CAD. Conclusion: The GRS is more associated with SS than TRI in predicting the severity of CAD in patients with ACS.

Keywords: acute coronary syndrome, GRACE risk score, SYNTAX score, TIMI risk index


Adem Bekler, Burak Altun, Emine Gazi, Ahmet Temiz, Ahmet Barutçu, Ömer Güngör, Muhammed Turgut Alper Özkan, Sedat Özcan, Sabri Gazi, Bahadır Kırılmaz. Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome. Anatol J Cardiol. 2015; 15(10): 801-806


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