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 Figure 1 – Receiver operating characteristic (ROC) curves regarding risks scores and in-hospital mortality, in the total population. TIMI: Thrombolysis in Myocardial Infarction; PURSUIT: Platelet glycoprotein IIb/IIa in Unstable angina: Receptor Suppression Using Integrilin Therapy; 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. Table 5 – Predictive accuracy and goodness of fit of the scores at predicting the occurrence of all-cause mortality and non-fatal ACS at one‑year follow-up and comparation with the ProACS risk score All-cause mortality and non-fatal ACS at one-year follow-up c-statistics (95% CI) p-value p-value (Hosmer– Lemeshow χ 2 ) Comparing with the ProACS Risk Score ∆ p-value TIMI for STEMI 0.695 (0.650-0.741) < 0.001 0.033 0.0323 0.0656 PURSUIT 0.682 (0.634-0.730) < 0.001 0.001 0.0185 0.3846 SRI 0.680 (0.632-0.729) < 0.001 0.042 0.0171 0.3854 GRACE 0.684 (0.639-0.729) < 0.001 0.022 0.0209 0.1608 EMMACE 0.673 (0.623-0.723) < 0.001 0.681 0.00997 0.6157 CHA 2 DS 2 -VASc-HS 0.622 (0.570-0.673) < 0.001 0.027 0.0414 0.2093 ACTION Registry–GWTG 0.690 (0.643-0.737) < 0.001 0.005 0.0267 0.0567 C-ACS 0.550 (0.497-0.603) 0.057 0.366 0.113 0.0007 ProACS 0.663 (0.617-0.709) < 0.001 0.015 N/A N/A ∆: difference between the two AUC (area under the curve). TIMI: Thrombolysis in Myocardial Infarction; PURSUIT: Platelet glycoprotein IIb/IIa in Unstable angina: Receptor Suppression Using Integrilin Therapy; 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. c-statistic of 0.814. These RS are simple and intuitive, however, derivation from large trial databases tend to overlook specific high-risk patients. 3-5 The GRACE risk score was developed using an international registry, much more representative of real-world patients, with a total of 11,389 patients enrolled. 6 The GRACE risk score outperformed previous RS which tended to use clinical trial data. GRACE showed good predictive capacity for in-hospital mortality and at 6-month follow-up. 6,17 This risk score was updated using a cohort of 48,023 patients 18 and has become the most widely used risk score both in STEMI and NSTEMI/UA. 1,2 The EMMACE risk score was also developed from patients admitted for ACS over a 3-month period in 1995, compiling a total of 2,135 patients. 9 Amathematical formula only comprising 3 variables (age, heart rate and systolic blood pressure) was formulated and revealed good performance at predicting mortality at 30 days (c-statistics of 0.76 to 0.79). This risk score is simple and reproducible. 9 26