Q2. What future works have the authors mentioned in the paper "Timi, grace and alternative risk scores in acute coronary syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients" ?
This study suggests that these other scores may be potentially useful and should be further researched.
Q3. What was the method used to evaluate the ACS7 derivation studies?
Statistical pooling was performed according to a random-effect model with generic inverse-variance weighting and computing c-index of the validation scores with 95% confidence intervals using RevMan 5 (The Cochrane Collaboration, The Nordic Cochrane Centre, and Copenhagen, Denmark).
Q4. What was the effect of random effect methods on AUC?
Heterogeneity ranged from low to high, thus the authors performed their analysis with random effect methods; however the authors also used fixed models, with no effect on AUC.
Q5. What were the limitations of the present study?
Most of the included studies reported a low or moderate risk of selection and attrition bias, while attrition and adjudication were mostly appraised as moderate.
Q6. What was the risk of bias in the ACS7 study?
Among all studies, aboutthree quarters of patients underwent a percutaneous revascularization, with rates of MACE ranging from 4.7% to 11% and of death from 4.2% to 11%.
Q7. What was the long term AUC of the GRACE score?
The long term AUC of the GRACE score was 0.84, while for the Zhong et al. [15] score the AUC was 0.81 (95% CI=0.71–0.86).18 derivation studies [7,11,20,31–45] with 56,560 UA/ NSTEMI patients and 18 validation cohorts [18,20,22,24,28, 30,32–36,46–52] with 56,673 patients were included.
Q8. What is the average AUC of a study?
While about half of derivation studies consist of dataderived from randomized clinical trials, almost all validation study data came from observational registries, most of them located in Europe and in North America.
Q9. What was the AUC of the TIMI validation studies?
Pooled analysis of TIMI validation studies showed an AUC of 0.54 (95% CI=0.52–0.57) and 0.67 (95% CI=0.62– 0.71) at short and long term.
Q10. What is the highest AUC for pooled results?
Heterogeneity for pooled results :ACS and UA/NSTEMI studies, GRACE AUC is the highest in validation cohorts, both for evaluating short term outcomes and especially long term outcomewhich has been shown recentlyto be a challenge. [74]
Q11. What criteria were used to evaluate the study?
Inclusion criteria were (all had to be met for inclusion): (i) Human studies, (ii) Studies investigating patients presenting to hospital with ACS (i.e.UA, NSTEMIModifying the MOOSE item list in order to take into account the specific features of included studies [8], the authors separately abstracted and appraised study design, setting, data source and statistical methods for multivariable analysis, as well as, in keeping with The Cochrane Collaboration approach, the risk of analytical, selection, adjudication, detection and attrition bias (expressed as low, moderate, or high risk of bias, as well as incomplete reporting leading to inability to ascertain the underlying risk of bias).
Q12. What was the AUC of the GRACE short term derivation study?
As in ACS studies, validation cohorts included more NSTEMI patients than derivation ones (Table 2), with rates of PTCA ranging from 26 to 48%.
Q13. What is the AUC of the TIMI and GRACE risk scores?
Their work confirms that TIMI and GRACE risk scores are the only ones validated in multiple clinical setting, with GRACE showing a better performance with an AUC around 0.85.