Research Article

Diagnostic accuracy of TIMI versus GRACE score for prediction of death in patients presenting with Acute Non-ST Elevation Myocardial Infarction (NSTEMI)

Syed Haseeb Raza Naqvi, Tariq Abbas, Han Naung Tun*, Ali Ahmad Naqvi, Zubair Zaffar, Badar ul Ahad Gill and Nisar Ahmad

Published: 22 February, 2019 | Volume 4 - Issue 1 | Pages: 001-005

Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a significant risk of death.

Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction.

Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients.

Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%.

Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001032 Cite this Article Read Full Article PDF


TIMI; GRACE; Cardiac; Infarction; Acute; Risk; Elevation.


  1. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2011; 32: 2999-3054. Ref.: https://goo.gl/WfY3zj
  2. Gurm HS, Gore JM, Anderson FA, Wyman A, Fox KA, et a. Comparison of acute coronary syndrome in patients receiving versus not receiving chronic dialysis (from the Global Registry of Acute Coronary Events [GRACE] Registry). Am J Cardiol. 2012; 109: 19-25. Ref.: https://goo.gl/ABVHSK
  3. Amin ST, Morrow DA, Braunwald E, Sloan S, Contant C, et al. Dynamic TIMI risk score for STEMI. J Am Heart Assoc. 2013; 2: e003269. Ref.: https://goo.gl/RnTeiE
  4. D'Ascenzo F, Biondi-Zoccai G, Moretti C, Bollati M, Omedè P, et al. 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. Contemp Clin Trials. 2012; 33: 507-514. Ref.: https://goo.gl/2WRnz1
  5. Goldberg RJ, Gore JM, Alpert JS, Dalen JE. Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981): the Worcester Heart Attack Study. JAMA 1986; 255: 2774-2779. Ref.: https://goo.gl/X9s6tA
  6. Bata IR, Gregor RD, Eastwood BJ, Wolf HK. Trends in the incidence of acute myocardial infarction between 1984 and 1993-The Halifax County MONICA Project. Can J Cardiol. 2000; 16: 589-595. Ref.: https://goo.gl/iCLfmd
  7. Benter P, Gailani M, Gross P. Die Behandlung des akuten Koronarsyndroms ohne ST-Streckenelevation Neue Aspekte für die Koronarintervention. Clinical Research in Cardiology Supplements. 2008; 3: 71-77. Ref.: https://goo.gl/QuU2sr
  8. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2003; 24: 28-66. Ref.: https://goo.gl/d2imY9
  9. Birkhead J, Walker L, Pearson M, Weston C, Cunningham A, et al. Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP). Heart. 2004; 90: 1004-1009. Ref.: https://goo.gl/GzRegL
  10. Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004; 291: 2727-2733. Ref.: https://goo.gl/FBuCYP
  11. Correia LC, Garcia G, Kalil F, Ferreira F, Carvalhal M, et al. Prognostic value of TIMI score versus GRACE score in ST-segment elevation myocardial infarction. Arquivos brasileiros de cardiologia. 2014; 103: 98-106. Ref.: https://goo.gl/V9eJLh
  12. Terkelsen CJ, Lassen JF, Nørgaard BL, Gerdes JC, Jensen T, et al. Mortality rates in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: observations from an unselected cohort. Eur Heart J. 2005; 26: 18-26. Ref.: https://goo.gl/HpkzX8
  13. GRACE Investigators. Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J. 2001; 141: 190-199. Ref.: https://goo.gl/in5nmw
  14. Volmink J, Newton J, Hicks N, Sleight P, Fowler G, et al. Coronary event and case fatality rates in an English population: results of the Oxford myocardial infarction incidence study. Heart. 1998; 80: 40-44. Ref.: https://goo.gl/YwEMKD
  15. Bahit MC, Granger CB, Wallentin L. Persistence of the prothrombotic state after acute coronary syndromes: implications for treatment. Am Heart J. 2002; 143: 205-216. Ref.: https://goo.gl/ikJQ55
  16. Davies MJ. The pathophysiology of acute coronary syndromes. Heart. 2000; 83: 361-366. Ref.: https://goo.gl/ZktyVc

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More