P847Performance of the GRACE score in patients with type 1 and type 2 myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J D Hung ◽  
A Roos ◽  
A S V Shah ◽  
A Anand ◽  
F E Strachan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Receiver Operator Curve ◽  
Coronary Syndrome ◽  
Risk Stratification Tool ◽  
One Year ◽  
Grace Score ◽  
Operator Curve

Abstract Introduction The Global Registry of Acute Coronary Events (GRACE) score is a widely used risk stratification tool in the evaluation of patients with myocardial infarction. However, the performance of GRACE in patients with myocardial infarction secondary to oxygen supply-demand imbalance in the absence of atherothrombosis (type 2 myocardial infarction), is uncertain. Outcomes in patients with type 2 myocardial infarction are poor, and a risk stratification tool is urgently required. Methods We assessed the GRACE score in two cohorts of consecutive patients presenting to the Emergency Department with suspected acute coronary syndrome. One cohort was recruited as part of a stepped wedge cluster randomised controlled trial across ten hospitals in Scotland, and one cohort from a large tertiary centre in Sweden. All diagnoses were adjudicated according to the Fourth Universal Definition. We applied the GRACE 2.0 algorithm to estimate death at one year. We assessed model discrimination using the area under the receiver-operator-curve (AUC), and compared AUC between type 1 and type 2 myocardial infarction using the DeLong test. Calibration was assessed using the Hosmer-Lemeshow (HL) goodness of fit test. Results We identified 2,538 and 1,080 patients with type 1 myocardial infarction from the Scottish and Swedish cohorts, with death from any cause occurring in 378 (14.9%) and 112 (10.4%) patients, respectively. The AUC for the GRACE score was 0.843 (0.823–0.864) and 0.848 (0.810–0.886). There were 642 and 247 patients with type 2 myocardial infarction in the Scottish and Swedish cohorts, respectively, with death occurring in 144 (22.4%) and 57 (23.1%) patients. The AUC was 0.708 (0.662–0.754) and 0.733 (0.657–0.808), (P<0.001 for both compared to type 1 myocardial infarction). The results of the HL Test suggest that the calibration of the GRACE 2.0 score needs further improvement (Table). Evaluation of GRACE 2.0 algorithm Type 1 Myocardial Infarction Type 2 Myocardial Infarction Scotland (n=2,538) Sweden (n=1,080) Scotland (n=642) Sweden (n=247) Deaths 378 (14.9%) 112 (10.4%) 144 (22.4%) 57 (23.0%) AUC (C-statistic) 0.843 (0.823–0.864) 0.848 (0.810–0.886) 0.708 (0.662–0.754) 0.733 (0.657–0.808) P-value for HL <0.001 <0.001 <0.001 <0.001 AUC: Area Under the receiver-operator Curve; HL: Hosmer-Lemeshow test. Figure 1. ROC curves Conclusions The GRACE score provided excellent discrimination for all cause death at one year in two contemporary consecutive patient cohorts with tye 1 myocardial infarction. In patients with type 2 myocardial infarction, GRACE performed well, but recalibration or the development of novel risk scores has the potential to improve risk stratification.

scholarly journals Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction

2020 ◽  
Author(s):  
John Hung ◽  
Andreas Roos ◽  
Erik Kadesjö ◽  
David A McAllister ◽  
Dorien M Kimenai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Receiver Operating Curve ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Global Registry ◽  
Grace Score

Abstract Aims The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. Methods and results In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong’s test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82–0.85] and 0.85 (95% CI 0.81–0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70–0.77) and 0.73 (95% CI 0.66–0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P &lt; 0.001 and P = 0.008, respectively). Conclusion The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. Trial registration ClinicalTrials.gov number, NCT01852123.

The mechanism of supply-demand imbalance and clinical outcomes in patients with type 2 myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bularga ◽  
A Anand ◽  
F.E Strachan ◽  
K.K Lee ◽  
S Stewart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Funding Source ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Randomised Controlled

Abstract Background Type 2 myocardial infarction is common and associated with substantial risk of adverse clinical outcomes, worse than type 1 myocardial infarction, with as few as 30% of patients still alive at five years. However, this broad diagnostic term encompasses multiple mechanisms of supply-demand imbalance, which may be associated with different risks of adverse outcomes. Purpose We aimed to assess the prevalence and clinical outcomes of different mechanisms of supply-demand imbalance related to survival in the High-STEACS (High-Sensitivity Troponin in the Evaluation of patients with Acute Coronary Syndrome) randomised controlled trial. Methods The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland, including 48,282 consecutive patients with suspected acute coronary syndrome. The diagnosis was adjudicated according to the Fourth Universal Definition of Myocardial Infarction. In patients with type 2 myocardial infarction, we prospectively adjudicated the cause for supply demand imbalance. Linkage of electronic healthcare records was used to track investigation, treatments and clinical outcomes. We used the Kaplan-Meier method, the log rank test and cox regression models adjusted for age, sex, renal function and co-morbidities to evaluate the risk of future all-cause mortality between categories. Results We identified 1,121 patients with type 2 myocardial infarction (age 74- ± 14, 55% female). At one year, death from any cause occurred in 23% (258/1,121) of patients. The most common reason for supply-demand imbalance was tachyarrhythmia in 55% (616/1,121), followed by hypoxaemia in 20% (219/1,121) of patients. Tachyarrhythmia was associated with reduced future risk of all-cause mortality (adjusted HR 0.69, 95% CI 0.43–1.09), similar to those with type 1 myocardial infarction. Comparatively, patients with hypoxaemia appeared at highest risk (adjusted HR 1.75, 95% CI 1.09–2.80). Conclusion The mechanism of myocardial oxygen supply-demand imbalance is associated with future prognosis, and should be considered when risk stratifying patients with type 2 myocardial infarction. Supply-demand imbalance survival Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

247Safety and efficacy of high-sensitivity cardiac troponin for risk stratification in patients with suspected acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bularga ◽  
A Anand ◽  
F E Strachan ◽  
K K Lee ◽  
S Stewart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Cardiac Troponin ◽  
Cardiac Death ◽  
Controlled Trial ◽  
High Sensitivity ◽  
Composite Outcome ◽  
Coronary Syndrome

Abstract Background Guidelines acknowledge the emerging role of high-sensitivity cardiac troponin (hs-cTn) assays for the risk stratification and rapid rule-out of myocardial infarction, but multiple approaches have been described. We previously demonstrated the utility of a single hs-cTnI concentration <5 ng/L at presentation to risk stratify patients with suspected acute coronary syndrome (ACS). Purpose To assess the safety and efficacy of a hs-cTnI concentration <5 ng/L at presentation in consecutive patients included in the High-STEACS (High-SensitivityTroponin in the Evaluation of patients with Acute Coronary Syndrome) randomised controlled trial. Methods The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland that included 48,282 patients in whom high-sensitivity cardiac troponin was requested by the attending clinician for evaluation of suspected ACS. Patients with ST-segment elevation myocardial infarction (STEMI) were excluded. We evaluated the negative predictive value (NPV) and sensitivity of a presentation hs-cTnI <5 ng/L for a composite outcome of type 1 myocardial infarction, or subsequent type 1 myocardial infarction or cardiac death at 30 days. To assess safety, we report the one-year risk of type 1 myocardial infarction or cardiac death. To assess efficacy, we report the proportion of patients with cardiac troponin <5 ng/L at presentation. Results We included 47,101 consecutive patients in the analysis (mean 61±17 years old, 47% female). Of these patients, 27,500 (58%) had a cardiac troponin <5 ng/L at presentation. Overall, 4,313/47,101 (9%) patients had a composite outcome at 30 days, but the event rate was only 0.4% in those with troponin <5 ng/L (98/27,500). The NPV for the composite outcome in those <5 ng/L was 99.7% (95% confidence intervals [CI] 99.6–99.7) and the sensitivity was 98.0% (95% CI 97.6–98.4). In those without evidence of myocardial injury at presentation (hs-cTnI <99thcentile), type 1 myocardial infarction or cardiac death at one year occurred in 197 (0.7%) patients with cardiac troponin <5 ng/L, compared to 647 (5.5%) of those ≥5 ng/L. The NPV was unchanged across all age groups, although efficacy fell as fewer older patients had hs-cTnI concentrations below the risk stratification threshold (see Figure). Conclusion A hs-cTnI concentration <5 ng/L at presentation identifies the majority of patients with suspected ACS as low-risk of early or late cardiac events. Although the proportion identified as low risk is reduced in older populations, the safety of this risk stratification approach is maintained across patients of all ages. Acknowledgement/Funding British Heart Foundation

P1730Serial high-sensitivity troponin I measurements to discriminate type 2 from type 1 myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D A Psyrakis ◽  
J Bormann ◽  
B Von Jeinsen ◽  
J S Wolter ◽  
M Weferling ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
High Sensitivity ◽  
High Morbidity ◽  
Absolute Change ◽  
Coronary Syndrome ◽  
High Sensitivity Troponin ◽  
Rule Out

Abstract Background Acute myocardial infarction (MI) is associated with high morbidity and mortality. A robust differentiation between type 1 and type 2 MI (T1/T2MI) has prognostic and therapeutic implications. We investigated whether serial high-sensitivity cardiac troponin I measurements could reliably discriminate T1MI from T2MI in patients presenting with a non-ST elevation myocardial infarction (NSTEMI). Methods We used data from a prospective acute coronary syndrome biomarker registry of patients with suspected MI that presented at or were transferred to one of two study centres. Here, we analysed an unselected group of 265 NSTEMI patients (67.2% males). Blood was drawn on admission and after 3 hours. High-sensitivity troponin I (hs-cTnI) was measured in frozen samples by a technician blinded to patient characteristics. T1MI or T2MI was defined as the gold-standard study diagnosis by two independent cardiologists based on all available data according to the Third Universal Definition of MI. Results A diagnosis of T2MI was made in 55 patients (20.8%) in the NSTEMI cohort. T2MI patients did not differ from T1MI patients regarding age, gender, traditional risk factors, or percentage of those with a history of coronary artery disease. Median baseline hs-cTnI levels were higher in T1MI (436.25; IQR 63.7–1918.8 ng/L) than in T2MI patients (48.4; IQR 11.7–305.9 ng/L; p<0.001). Absolute change in hs-cTnI concentration between 0 and 3 h was greater in T1MI than in T2MI patients with Dhs-cTnI 93.6 ng/L (IQR 13.5–815.3 ng/L) vs. 20.4 ng/L (IQR 2.5–106.5 ng/L) (p<0.001). hs-cTnI yielded an area under the receiver operator characteristics (AUROC) curve for identifying T2MI at baseline of 0.71 (IQR 0.64–0.79) and after 3 h of 0.7 (IQR 0.61–0.78).Dhs-cTnI was associated with an AUROC of 0.68 (IQR 0.6–0.76). Regarding a rule-out approach, Youden-optimized cut-offs for hs-cTnI at baseline as well as for the absolute change in hs-cTnI concentration were calculated (186.5 ng/L; 154.4 ng/L). Use of these two criteria yielded a sensitivity of 89% (78–96%) and a negative predictive value of 95% (89–98%) to exclude T2MI. 49 of 55 T2MI patients would have been ruled out using this algorithm. Conclusion Our data show that hs-cTnI concentrations differ between patients presenting with T1 and T2MI. The concentration of hs-cTnI and its change over time has the potential to rule out T2MI and therefore to identify patients who might benefit from an early invasive management. The differentiation between T1MI and T2MI by using hs-cTnI is nevertheless challenging, and further research on specific algorithms is needed. Acknowledgement/Funding 3German Center for Cardiovascular Research (DZHK), Partnersite Rhein Main, Bad Nauheim, Germany

Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score

2016 ◽  
Vol 7 (2) ◽  
pp. 129-138 ◽  
Author(s):  
Roland Klingenberg ◽  
Soheila Aghlmandi ◽  
Lorenz Räber ◽  
Baris Gencer ◽  
David Nanchen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Improve Risk Stratification ◽  
St Segment ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Grace Score

Background: Clinical scores and biomarkers improve risk stratification of patients with acute coronary syndromes. However, little is known about their value in patients referred for coronary angiography. Methods: Consecutive patients admitted at four Swiss university hospitals with a diagnosis of acute coronary syndrome were enrolled into the SPUM-ACS Biomarker Cohort between 2009 and 2012. Patients were followed at 30 days and 1 year with assessment of adjudicated events including all-cause mortality and the composite of all-cause mortality or non-fatal recurrent myocardial infarction. Results: Events and biomarkers were analysed in 1892 patients (52.4% with ST-segment elevation myocardial infarction, 43.3% with non-ST-segment elevation myocardial infarction and 4.3% with unstable angina). Death at 30 days occurred in 35 patients (1.9%) and at 1 year in 80 patients (4.3%). The choice of troponin assay (conventional versus high sensitivity) to calculate the Global Registry of Acute Coronary Events (GRACE) score did not affect risk prediction. The prognostic accuracy of the GRACE score was improved when combined with three individual biomarkers including high sensitivity troponin T (hsTnT), N-terminal-pro B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) to yield a 9% increment (C-statistic 0.73–>0.82) for the discrimination of short-term risk for all-cause mortality. In contrast, the novel biomarkers placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the ratio sFlt-1/PlGF did not improve risk stratification. Conclusions: In patients with acute coronary syndrome referred for coronary angiography, combinations of biomarkers including hsTnT, NT-proBNP and hsCRP with the GRACE score enhanced risk discrimination. Clinical Trials Registration: NCT01000701

scholarly journals Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial Injury and Myocardial Infarction

Circulation ◽  
2021 ◽  
Author(s):  
Ryan Wereski ◽  
Dorien M. Kimenai ◽  
Caelan Taggart ◽  
Dimitrios Doudesis ◽  
Kuan Ken Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Controlled Trial ◽  
Rate Of Change ◽  
Coronary Syndrome ◽  
Diagnostic Threshold

Background: Whilst the 99th percentile is the recommended diagnostic threshold for myocardial infarction, some guidelines also advocate the use of higher troponin thresholds to rule-in myocardial infarction at presentation. It is unclear whether the magnitude or change in troponin concentration can differentiate causes of myocardial injury and infarction in practice. Methods: In a secondary analysis of a multi-centre randomized controlled trial, we identified 46,092 consecutive patients presenting with suspected acute coronary syndrome without ST-segment elevation myocardial infarction. High-sensitivity cardiac troponin I concentrations at presentation and on serial testing were compared between patients with myocardial injury and infarction. The positive predictive value (PPV) and specificity were determined at the sex-specific 99th percentile upper reference limit (URL), and rule-in thresholds of 64 ng/L and 5-fold of the URL for a diagnosis of type 1 myocardial infarction. Results: Troponin was above the 99th percentile in 8,188 (18%) patients. The diagnosis was type 1 or type 2 myocardial infarction in 50% and 14%, and acute or chronic myocardial injury in 20% and 16%, respectively. Troponin concentrations were similar at presentation in type 1 (median [25th percentile - 75th percentile] 91 [30-493] ng/L) and type 2 (50 [22-147] ng/L) myocardial infarction, and in acute (50 [26-134] ng/L) and chronic (51 [31-130] ng/L) myocardial injury. The 99th percentile and rule-in thresholds of 64 ng/L and 5-fold URL gave a PPV of 57% (95% confidence interval [CI] 56-58%), 59% (58-61%) and 62% (60-64%), and a specificity of 96% (96-96%), 96% (96-96%) and 98% (97-98%), respectively. The absolute, relative and rate of change in troponin concentration was highest in patients with type 1 myocardial infarction (P<0.001 for all). Discrimination improved when troponin concentration and change in troponin were combined compared to troponin concentration at presentation alone (area under curve, 0.661 [0.642-0.680] versus 0.613 [0.594-0.633]). Conclusions: Although we observed important differences in the kinetics, cardiac troponin concentrations at presentation are insufficient to distinguish type 1 myocardial infarction from other causes of myocardial injury or infarction in practice and should not guide management decisions in isolation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01852123

scholarly journals In-hospital mortality in patients with NON-ST segment elevation myocardial infarction in relation to high risk global registry of acute cardiac events score.

2020 ◽  
Vol 27 (11) ◽  
pp. 2433-2437
Author(s):  
Ariz Samin ◽  
Syed Hassan Mustafa ◽  
Sajid Khan ◽  
Saamia Arshad ◽  
Noor ul Huda ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Risk Scores ◽  
Outcome Variable ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Global Registry ◽  
Grace Score

Objectives: Presage for early risk stratification is consequential for long term clinical outcomes in patients with non-ST elevation acute coronary syndrome. Thrombolysis in Myocardial Infarction risk scores (TIMI) and Global Registry of Acute Cardiac Events (GRACE) have been most extensively investigated risk scores till date for risk stratification in patients admitted with Cardiovascular disease. Study Design: Descriptive Case Series. Setting: Department of Cardiology Ayub Teaching Hospital, Abbottabad. Period: 4th August 2016 to 4th April 2017. Material & Methods: 199 patients diagnosed with NSTEMI were included in the study after obtaining an apprised consent. Risk stratification of each patient was done according to GRACE score. Patients were followed up during their hospital stay and their outcome was recorded on a pre-designed pro forma. The outcome was described as either death or discharge. Results: Mean±SD GRACE score was 156.12±20.65. The overall mortality in the study population was 11.6% (n=23). When the outcome variable was stratified according to age, gender, diabetes mellitus, obesity and hypertension, results were found in case of hypertension (p< 0.05), and statistically no significant in the case of other variables. Conclusion: A high risk GRACE score is associated with increased in-hospital mortality in patients with NSTEMI.

scholarly journals Etiology of Acute Coronary Syndrome after Noncardiac Surgery

2018 ◽  
Vol 128 (6) ◽  
pp. 1084-1091 ◽  
Author(s):  
Mohammad A. Helwani ◽  
Amit Amin ◽  
Paul Lavigne ◽  
Srikar Rao ◽  
Shari Oesterreich ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Noncardiac Surgery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Abstract Background The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia. Methods In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis). Results Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively. Conclusions The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.

A real world analysis of NSTE-ACS in more than 4000 patients: accuracy of GRACE and TIMI scores in mortality prediction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Borges-Rosa ◽  
J Ferreira ◽  
M Oliveira-Santos ◽  
S Monteiro ◽  
F Goncalves ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Real World ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
Timi Score ◽  
One Year ◽  
Grace Score

Abstract Introduction The TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) risk scores identify high-risk patients with Non-ST elevation acute coronary syndrome (NSTE-ACS) who can benefit from an early invasive strategy. Purpose We aimed to compare both scores predictive accuracy for mortality in a real-world cohort of patients presenting with NSTE-ACS. Methods We retrospectively evaluated 4264 patients admitted to our coronary intensive care unit between 2004 and 2017 with a diagnosis of NSTE-ACS. The TIMI and GRACE scores were calculated for each patient, and all-cause mortality was recorded during hospitalization, at one month and one year. To better characterize global troponin release, we defined Total Troponin (TT) as the sum of initial and discharge troponin. We used the area under the receiver operating characteristic curve (AUC) to compare the predictive value of both scores for mortality during hospitalization, at one month and one year. Results Mean patient age was 67.6±12.4 years and 66.4% were male (n=2833). Mean GRACE score was 124.6±35.8 and mean TIMI score was 2.7±1.6. There was a weak correlation between GRACE and TIMI score (r=0.3, p&lt;0.001). In-hospital mortality was 2.8%: the GRACE score showed higher AUC (0.845, 95% CI 0.805–0.804, p&lt;0.001) compared to TIMI (0.581, 95% CI 0.519–0.643, p=0.009) (Figure 1). Mortality at one month was 5.1%: the GRACE score showed higher AUC (0.842, 95% CI 0.814–0.869, p&lt;0.001) compared to TIMI (0.586, 95% CI 0.541–0.630, p&lt;0.001). Mortality at one year was 11.4%: the GRACE score showed higher AUC (0.811, 95% CI 0.789–0.822, p&lt;0.001) compared to TIMI (0.591, 95% CI 0.560–0.622, p&lt;0.001) (Fig. 1). Analyzing Unstable Angina and Non-ST segment elevation myocardial infarction separately, the GRACE score also showed higher AUC compared to TIMI. Exploratory analyses revealed a combined indicator (GRACE score + TT) which had higher AUC (0.876, 95% CI 0.844–0.907, p&lt;0.001) compared to GRACE score (0.855, 95% CI 0.823–0.887, p&lt;0.001) for one month mortality and for one year mortality (0.818, 95% CI 0.792–0.844, p&lt;0.001 vs. 0.813, 95% CI 0.788–0.839, p&lt;0.001). Conclusion In patients with NSTE-ACS, GRACE risk score is a better predictor of in-hospital, one month and one-year mortality, compared to TIMI risk score. TT, as a measure of ischemia burden, might improve accuracy of GRACE score in predicting short and long-term mortality. Figure 1 Funding Acknowledgement Type of funding source: None

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