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Evaluation of risk scores for risk stratification of acute coronary syndromes
St Michael's Hospital, University of Toronto, Toronto, Canada
Correspondence to:
Dr A T Yan, St Michael's Hospital, University of Toronto, 30 Bond Street, Queen 6-030, Toronto, M5B 1W8 Canada; yana@smh.toronto.on.ca
| The first 150 words of the full text of this article appear below. |
To the editor: We read with interest the study by Dr Gale and colleagues.1 We fully agree with the authors that age, heart rate and systolic blood pressure are among the most powerful prognosticators in acute coronary syndromes (ACS).2 3 However, we believe that several key points deserve clarification.
First, by dichotomising continuous variables such as creatinine and Killip class (eg, Killip class II and IV would both be considered equivalent to "cardiac failure"), substantial prognostic information would be lost, so that performance of risk scores consisting of such variables would be underestimated. Furthermore, by not using the coefficients derived from the original risk scores (ie, the logistic regression models were reconstructed),1 this study essentially compares the predictive value of various combinations of clinical variables, rather than the actual risk scores themselves.
Second, it is critical to recognise the inherent trade-offs between discrimination and calibration.4 An established prognosticator with an
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- The authors’ reply:
- C P Gale, S O M Manda, B A Cattle, C F Weston, J S Birkhead, P D Batin, A S Hall, and R M West
Heart 2009 95: 1019-1020.[Extract] [Full Text] [PDF]
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