All cases of acute coronary syndromes were assigned to one of the following categories: ST-elevation myocardial infarction, non-ST elevation myocardial infarction, or unstable angina. Standardized definitions of all patient-related variables and clinical diagnoses were used. Demographic characteristics, medical history, presenting symptoms, duration of pre-hospital delay, biochemical and electrocardiography findings, treatment practices and a variety of hospital outcome data were obtained. Data were collected by trained personnel (physicians/nurses/medical residents) from review of hospital medical records using a standardized six-page case report form. Patient consent was either written or verbal as per the institutional review board, verbal consent was obtained from subjects who did not return a written consent and/or did not opt out of the registry. Informed consent was obtained for all patients enrolled after Janufollowing enactment of the HIPAA Privacy Rule. The protocol was approved by the institutional review board at the University of Michigan. ACS was defined as presentation with symptoms of ischemia along with qualifying electrocardiographic changes, positive cardiac enzymes, new documentation of coronary artery disease (CAD) or prior existence of CAD. The study sample consisted of 3451 consecutive patients admitted to the University of Michigan between January 1999 and December 2005 with a discharge diagnosis of ACS. Moreover, we sought to investigate the relative contributions of model simplicity and model composition to any observed prognostic differences between the TIMI and GRACE risk scores. This study aimed to evaluate the prognostic abilities of the TIMI and GRACE risk scores over a broad-spectrum of community-derived ACS patients (UA/NSTEMI and STEMI) admitted to a tertiary care center. Comparisons of the TIMI and GRACE scores in STEMI patients remain unexplored. Recent studies have suggested the superiority of the GRACE risk scores as compared to the TIMI UA/NSTEMI score in UA and/or NSTEMI patients. Though slightly more complex, the GRACE risk scores for in-hospital and 6-month mortality are derived from a more representative community-based registry. The TIMI risk scores for Unstable Angina/Non ST-Elevation Myocardial Infarction (UA/NSTEMI) and for ST-Elevation Myocardial Infarction (STEMI) patients are simple, integer-based scores derived from selected clinical-trial cohorts. Both of these scoring systems have been shown to predict the response of ACS patients to various treatment modalities, and may therefore significantly influence therapeutic decision-making. Current AHA/ACC guidelines promote the use of the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores to evaluate the in-hospital and post-discharge risk of ACS patients. Risk stratification is integral to the management of patients presenting with Acute Coronary Syndromes (ACS). Study limitations included unaccounted for confounders inherent to observational, single institution studies with moderate sample sizes. An analysis of refitted multivariate models demonstrated a marked improvement in the discriminative power of the TIMI UA/NSTEMI model with the incorporation of heart failure and hemodynamic variables. There were 137 in-hospital deaths (4%), and among the survivors, 234 (7.4%) died by 6 months post-discharge. The predictive abilities of the TIMI and GRACE scores for in-hospital and 6-month mortality were assessed by calibration and discrimination. ACS patients admitted to the University of Michigan between 19 were divided into UA/NSTEMI (nā=ā2753) and STEMI (nā=ā698) subpopulations.
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