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GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes

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GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes. / Jobs, Alexander; Boeddinghaus, Jasper; Neumann, Johannes Tobias; Goßling, Alina; Sörensen, Nils A; Twerenbold, Raphael; Nestelberger, Thomas; Lopez-Ayala, Pedro; Gimenez, Maria Rubini; Miro, Oscar; Koechlin, Luca; Buergin, Natacha; Feistritzer, Hans-Josef; Collet, Jean-Philippe; Bhatt, Deepak L; Granger, Christopher B; Blankenberg, Stefan; Desch, Steffen; Mueller, Christian; Westermann, Dirk; Thiele, Holger.

In: CLIN RES CARDIOL, Vol. 113, No. 4, 04.2024, p. 533-545.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Jobs, A, Boeddinghaus, J, Neumann, JT, Goßling, A, Sörensen, NA, Twerenbold, R, Nestelberger, T, Lopez-Ayala, P, Gimenez, MR, Miro, O, Koechlin, L, Buergin, N, Feistritzer, H-J, Collet, J-P, Bhatt, DL, Granger, CB, Blankenberg, S, Desch, S, Mueller, C, Westermann, D & Thiele, H 2024, 'GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes', CLIN RES CARDIOL, vol. 113, no. 4, pp. 533-545. https://doi.org/10.1007/s00392-023-02258-5

APA

Jobs, A., Boeddinghaus, J., Neumann, J. T., Goßling, A., Sörensen, N. A., Twerenbold, R., Nestelberger, T., Lopez-Ayala, P., Gimenez, M. R., Miro, O., Koechlin, L., Buergin, N., Feistritzer, H-J., Collet, J-P., Bhatt, D. L., Granger, C. B., Blankenberg, S., Desch, S., Mueller, C., ... Thiele, H. (2024). GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes. CLIN RES CARDIOL, 113(4), 533-545. https://doi.org/10.1007/s00392-023-02258-5

Vancouver

Jobs A, Boeddinghaus J, Neumann JT, Goßling A, Sörensen NA, Twerenbold R et al. GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes. CLIN RES CARDIOL. 2024 Apr;113(4):533-545. https://doi.org/10.1007/s00392-023-02258-5

Bibtex

@article{246080b7617f4f4393508b755ee4ac83,
title = "GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes",
abstract = "BACKGROUND: The GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn).METHODS: Prospectively enrolled patients presenting with symptoms suggestive of myocardial infarction (MI) in two large studies testing biomarker diagnostic strategies were included. Five GRACE risk scores were calculated. The amount of risk reclassification and the theoretical impact on guideline-recommended timing of invasive coronary angiography was studied.RESULTS: Overall, 8,618 patients were eligible for analyses. Comparing different GRACE risk scores, up to 63.8% of participants were reclassified into a different risk category. The proportion of MIs identified (i.e., sensitivity) dramatically differed between GRACE risk scores (range 23.8-66.5%) and was lower for any score than for the ESC 0/1 h-algorithm (78.1%). Supplementing the ESC 0/1 h-algorithm with a GRACE risk score slightly increased sensitivity (P < 0.001 for all scores). However, this increased the number of false positive results.CONCLUSION: The substantial amount of risk reclassification causes clinically meaningful differences in the proportion of patients meeting the recommended threshold for pursuing early invasive strategy according to the different GRACE scores. The single best test to detect MIs is the ESC 0/1 h-algorithm. Combining GRACE risk scoring with hs-cTn testing slightly increases the detection of MIs but also increases the number of patients with false positive results who would undergo potential unnecessarily early invasive coronary angiography.",
author = "Alexander Jobs and Jasper Boeddinghaus and Neumann, {Johannes Tobias} and Alina Go{\ss}ling and S{\"o}rensen, {Nils A} and Raphael Twerenbold and Thomas Nestelberger and Pedro Lopez-Ayala and Gimenez, {Maria Rubini} and Oscar Miro and Luca Koechlin and Natacha Buergin and Hans-Josef Feistritzer and Jean-Philippe Collet and Bhatt, {Deepak L} and Granger, {Christopher B} and Stefan Blankenberg and Steffen Desch and Christian Mueller and Dirk Westermann and Holger Thiele",
note = "{\textcopyright} 2023. The Author(s).",
year = "2024",
month = apr,
doi = "10.1007/s00392-023-02258-5",
language = "English",
volume = "113",
pages = "533--545",
journal = "CLIN RES CARDIOL",
issn = "1861-0684",
publisher = "D. Steinkopff-Verlag",
number = "4",

}

RIS

TY - JOUR

T1 - GRACE scores or high-sensitivity troponin for timing of coronary angiography in non-ST-elevation acute coronary syndromes

AU - Jobs, Alexander

AU - Boeddinghaus, Jasper

AU - Neumann, Johannes Tobias

AU - Goßling, Alina

AU - Sörensen, Nils A

AU - Twerenbold, Raphael

AU - Nestelberger, Thomas

AU - Lopez-Ayala, Pedro

AU - Gimenez, Maria Rubini

AU - Miro, Oscar

AU - Koechlin, Luca

AU - Buergin, Natacha

AU - Feistritzer, Hans-Josef

AU - Collet, Jean-Philippe

AU - Bhatt, Deepak L

AU - Granger, Christopher B

AU - Blankenberg, Stefan

AU - Desch, Steffen

AU - Mueller, Christian

AU - Westermann, Dirk

AU - Thiele, Holger

N1 - © 2023. The Author(s).

PY - 2024/4

Y1 - 2024/4

N2 - BACKGROUND: The GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn).METHODS: Prospectively enrolled patients presenting with symptoms suggestive of myocardial infarction (MI) in two large studies testing biomarker diagnostic strategies were included. Five GRACE risk scores were calculated. The amount of risk reclassification and the theoretical impact on guideline-recommended timing of invasive coronary angiography was studied.RESULTS: Overall, 8,618 patients were eligible for analyses. Comparing different GRACE risk scores, up to 63.8% of participants were reclassified into a different risk category. The proportion of MIs identified (i.e., sensitivity) dramatically differed between GRACE risk scores (range 23.8-66.5%) and was lower for any score than for the ESC 0/1 h-algorithm (78.1%). Supplementing the ESC 0/1 h-algorithm with a GRACE risk score slightly increased sensitivity (P < 0.001 for all scores). However, this increased the number of false positive results.CONCLUSION: The substantial amount of risk reclassification causes clinically meaningful differences in the proportion of patients meeting the recommended threshold for pursuing early invasive strategy according to the different GRACE scores. The single best test to detect MIs is the ESC 0/1 h-algorithm. Combining GRACE risk scoring with hs-cTn testing slightly increases the detection of MIs but also increases the number of patients with false positive results who would undergo potential unnecessarily early invasive coronary angiography.

AB - BACKGROUND: The GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn).METHODS: Prospectively enrolled patients presenting with symptoms suggestive of myocardial infarction (MI) in two large studies testing biomarker diagnostic strategies were included. Five GRACE risk scores were calculated. The amount of risk reclassification and the theoretical impact on guideline-recommended timing of invasive coronary angiography was studied.RESULTS: Overall, 8,618 patients were eligible for analyses. Comparing different GRACE risk scores, up to 63.8% of participants were reclassified into a different risk category. The proportion of MIs identified (i.e., sensitivity) dramatically differed between GRACE risk scores (range 23.8-66.5%) and was lower for any score than for the ESC 0/1 h-algorithm (78.1%). Supplementing the ESC 0/1 h-algorithm with a GRACE risk score slightly increased sensitivity (P < 0.001 for all scores). However, this increased the number of false positive results.CONCLUSION: The substantial amount of risk reclassification causes clinically meaningful differences in the proportion of patients meeting the recommended threshold for pursuing early invasive strategy according to the different GRACE scores. The single best test to detect MIs is the ESC 0/1 h-algorithm. Combining GRACE risk scoring with hs-cTn testing slightly increases the detection of MIs but also increases the number of patients with false positive results who would undergo potential unnecessarily early invasive coronary angiography.

U2 - 10.1007/s00392-023-02258-5

DO - 10.1007/s00392-023-02258-5

M3 - SCORING: Journal article

C2 - 37421436

VL - 113

SP - 533

EP - 545

JO - CLIN RES CARDIOL

JF - CLIN RES CARDIOL

SN - 1861-0684

IS - 4

ER -