ABC | Volume 113, Nº1, July 2019

Original Article Gil et al Risks scores in acute coronary syndromes Arq Bras Cardiol. 2019; 113(1):20-30 Table 1 – Characterization of the population (n=1,452) Male gender, % 70% Age, years 69.09 ± 13.2 Type of ACS STEMI 45.1% NSTEMI/UA 52.0% ACS with left bundle branch block 2.3% ACS with pacing rhythm 0.6% Systolic Blood Pressure at admission, mmHg 140.54 ± 30.4 Diastolic Blood Pressure at admission, mmHg 81.79 ± 17.7 Heart rate, beats per minute 79.29 ± 21.1 Killip-Kimbal class at admission I 70.7% II 22.0% III 5.0% IV 2.3% Maximum Killip-Kimbal class I 57.2% II 27.3% III 6.0% IV 9.4% Risk Factors Hypertension 65.8% Dyslipidaemia 46.6% Smoking habits 24.3% Diabetes mellitus 26.6% Previous known coronary disease 19.5% Chronic kidney disease 9.7% Cerebrovascular disease 9.4% Previous medication Statin 35.0% iRAAS 48.1% Beta-blocker 17.5% Antiplatelet therapy 34.4% Laboratory values Hemoglobin, g/dL 13.95 ± 2.5 Creatinine, mg/dL 1.20 ± 1.6 High sensitivity troponin I at admission, ng/dL 15.92 ± 49.7 Maximum troponin I, ng/dL 69.68 ± 104.7 Brain Natriuretic Peptide, pg/dL 552.58 ± 708.0 Medication and therapeutic strategy during hospitalization iRAAS 81.9% Beta-blocker 59.6% Nitrates 32.4% Antiarrhythmics 13.6% Continuation Inotropes 12.3% Invasive strategy 79.9% Left Ventricular Ejection Fraction, % 53.80 ± 12.3 Hospitalization days 7.3 ± 5.0 Risk Scores TIMI for STEMI 5 (3-7) PURSUIT 13 (10-14) SRI 26.04 (17.82 – 37.24) GRACE 144 (112-178.75) EMMACE 0.15 (0.06 – 0.33) CHA 2 DS 2 -VASc-HS 4 (3-5) ACTION Registry–GWTG 34 (27-44) C-ACS 1 (1-1) ProACS 2 (1-3) In-hospital Death 6.5% All-cause mortality and non-fatalACS at 1-year follow-up 9.9% ACS: acute coronary syndrome; STEMI: ST-segment elevation myocardial infarction; NSTEMI/UA: non-ST-segment elevation myocardial infarction/ unstable angina; iRAAS: renin angiotensin aldosterone system inhibitors. TIMI:Thrombolysis in Myocardial Infarction; PURSUIT: Platelet glycoprotein IIb/IIa in Unstable angina: Receptor Suppression Using Integrilin Therapy; SRI: Simple Risk Index; GRACE: Global Registry of Acute Coronary Events; EMMACE: Evaluation of the Methods and Management of Acute Coronary Events; C-ACS: Canada Acute Coronary Syndrome. Chronic kidney disease defined as reduction of glomerular filtration rate of under 60 ml/min/1.73 m 2 . Registry–GWTG and ProACS RS, with c-statistics around 0.900. Most RS, apart from the ProACS (p = 0.031), PURSUIT (p = 0.043), ACTION Registry–GWTG (p = 0.041) and C-ACS (p = 0.003) RS, showed an adequate fit, as demonstrated by a p-value for the Hosmer-Lemeshow (HL) test over 0.05. Comparing ProACS to the other RS revealed a statistically significant superiority of the first to all except the ACTION Registry–GWTG (p = 0.6647) and the GRACE (p = 0.0879). All RS consistently showed better discriminatory accuracy at predicting in-hospital mortality in STEMI patients. In this population, the ACTION Registry–GWTG and ProACS RS performed incredibly well, with c-statistics of over 0.900. Almost all RS revealed an adequate fit, except for the SRI (p = 0.011), the C-ACS (p = 0.005) and a trend from PURSUIT (p = 0.075). In STEMI patients, the ACTION Registry–GWTG (p = 0.882) and ProACS RS (p = 0.821) showed good fit. The ProACS RS demonstrated statistically significant superior discriminatory accuracy when compared to all other RS, except for ACTION Registry–GWTG (p = 0.2248). In the NSTEMI population, the RS performed slightly worse when compared to STEMI patients. ProACS, ACTION Registry–GWTG and GRACE scores were the RS with the highest discriminatory accuracy at predicting in‑hospital mortality, with c-statistics of 0.898, 0.895 and 0.878 respectively. ProACS also demonstrated significant superiority, except when compared to the aforementioned RS. 22