Eighty-two studies were included in the review. Follow-up times appeared to range from 30 to 392 days.The percentages of studies judged to be at low risk of bias were approximately 65% for selection bias, 45% for attrition bias, 41% for adjudication bias and 54% for analytical bias. Most of the rest were judged to be at moderate or unclear risk of bias.
ACS: There were seven derivation studies (25,525 patients). In these studies short-term TIMI had an AUC of 0.66 (95% CI 0.64 to 0.68) and short-term GRACE had an AUC of 0.83 (95% CI 0.82 to 0.84). There were 15 validation studies (257,654 patients). In these studies short-term TIMI had an AUC of 0.73 (95% CI 0.69 to 0.78) and short-term GRACE had an AUC of 0.82 (95% CI 0.80 to 0.89).
Unstable angina and NSTEMI: There were 18 derivation studies (56,560 patients) and 18 validation studies (56,673 patients). In the validation studies short-term TIMI had an AUC of 0.54 (95% CI 0.52 to 0.57) and short-term GRACE had an AUC of 0.83 (95% CI 0.79 to 0.87). Long-term TIMI had an AUC of 0.67 (95% CI 0.62 to 0.71) and long-term GRACE had an AUC of 0.80 (95% CI 0.74 to 0.89).
STEMI studies: There were 15 derivation studies (134,557 patients) and 17 validation studies (187,619 patients). Short-term TIMI had an AUC of 0.77 (95% CI 0.71 to 0.83) and short-term GRACE an AUC of 0.82 (95% CI 0.81 to 0.83). Long-term TIMI had an AUC of 0.77 (95% CI 0.72 to 0.85) and long-term GRACE had an AUC of 0.81 (95% CI 0.80 to 0.82).
Results for other risk scores were presented but data on these was very limited. There was no evidence of small-study bias.