Comparison of GRACE, HEART, and TIMI Risk Scores in Predicting In-Hospital Morbidity and Mortality in Acute Coronary Syndrome

Abstract

Background Uncertainty persists regarding the comparative predictive value of various risk scores for in-hospital outcomes in patients with acute coronary syndrome (ACS). Methodology A total of 259 patients with ACS were included in this study. Clinical and electrocardiographic data were collected, and in-hospital mortality and morbid events were documented. Using multivariate logistic regression analysis, predictors were identified. The discriminatory ability of the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and HEART (History, Electrocardiogram, Age, Risk factors, and Troponin) scores was determined using receiver operating characteristic curve analysis and compared using the DeLong test. Calibration was checked using the Hosmer-Lemeshow goodness-of-fit test. Results Hospital deaths were noted in 20 (7.7%) cases, and hospital morbidities in 61 (23.6%) cases. Significant predictors of mortality included older age, ST-segment changes, T-wave inversion, and decreased percutaneous coronary intervention. Predictors of morbidity included older age, lower body mass index, chronic kidney disease, and elevated creatinine level. Regarding multivariate analysis, age (odds ratio (OR) = 1.086; 95% confidence interval (CI) 1.005 to 1.173; p = 0.036) and TIMI score (OR = 1.542; 95% CI = 1.100 to 2.163; p = 0.012) were found to be independent predictors of mortality, whereas only the TIMI score was an independent predictor of morbidity (OR = 1.933; 95% CI = 1.512 to 2.472; p < 0.001). The TIMI score showed better discrimination than both the GRACE and HEART scores, which had area under the curve values of 0.728 for mortality and 0.737 for morbidity. Conclusions The TIMI risk score demonstrated superior predictive performance compared with GRACE and HEART scores for in-hospital complications in patients with ACS.