Predictive accuracy of Thrombolysis in Myocardial Infarction versus Global Registry of Acute Coronary Events Score for outcome in patients presenting with Acute Non-ST Elevation Myocardial Infarction

ABSTRACT Background: Non-ST elevation myocardial infarction (NSTEMI) is a prevalent subtype of acute coronary syndrome. Accurate risk stratification is critical in guiding timely interventions and optimizing prognosis. Thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores are widely used for risk prediction. However, their comparative performance in real-world clinical practice remains underexplored. Objectives: The objective of this study was to compare the predictive accuracy of TIMI and GRACE risk scores for inhospital major adverse cardiac events (MACEs), including death, heart failure, stroke, and need for revascularization, in patients presenting with NSTEMI. Materials and Methods: A prospective observational study was conducted at a tertiary care centre in Bengaluru. Seventy eight patients diagnosed with NSTEMI were enrolled and evaluated using TIMI and GRACE risk scores at admission. Patients were followed throughout their hospital stay for the occurrence of MACE. The predictive ability of each score was assessed using receiver operating characteristic curve analysis and diagnostic accuracy metrics. Results: Among the 78 patients, the incidence of inhospital MACE was significantly higher in patients with TIMI ≥ 4 and GRACE ≥ 140. The GRACE score demonstrated superior predictive performance (area under the curve [AUC] =0.891; 95% confidence interval [CI]: 0.820–0.961) compared to the TIMI score (AUC = 0.777; 95% CI: 0.667–0.887). GRACE also showed higher specificity (83.92%), negative predictive value (87.03%), and overall accuracy (79.48%) in identifying high-risk patients. Mortality was significantly higher in the GRACE ≥ 140 group (20.83% vs. 0%; P = 0.002). Conclusion: TIMI and GRACE scores are valuable tools for risk stratification in NSTEMI. However, the GRACE score offers superior predictive accuracy for inhospital adverse outcomes and should be preferred for comprehensive risk assessment.