Jeffrey Tadashi Sakamoto1, Nan Liu2, Zhi Xiong Koh3, Nicholas Xue Jin Fung4, Micah Liam Arthur Heldeweg5, Janson Cheng Ji Ng3, Marcus Eng Hock Ong6. 1. Duke University School of Medicine, USA. 2. Department of Emergency Medicine, Singapore General Hospital, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore. Electronic address: liu.nan@sgh.com.sg. 3. Department of Emergency Medicine, Singapore General Hospital, Singapore. 4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 5. Faculty of Medical Sciences, University of Groningen, The Netherlands. 6. Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Abstract
BACKGROUND: The HEART, TIMI, and GRACE scores have been applied in the Emergency Department (ED) to risk stratify patients with undifferentiated chest pain. This study aims to compare the accuracy of HEART, TIMI, and GRACE for the prediction of major adverse cardiac events (MACE) in high acuity chest pain patients. METHODS: Adult patients who presented with chest pain suggestive of cardiac origin in the most acute triage category at an academic ED from September 2010 to October 2015 were included. The HEART, TIMI, and GRACE scores were calculated retrospectively from prospectively collected data. The primary outcome was occurrence of MACE (mortality, AMI, PCI, CABG) within 30-days of initial presentation. RESULTS: 604 patients were included in the study. Patient demographics include an average age of 61years, 69% male, and 48% with history of ischemic heart disease. 36% of patients met the primary outcome. The c-statistics of HEART, TIMI, and GRACE were 0.78 (95% CI: 0.74-0.81), 0.65 (95% CI: 0.60-0.69), and 0.62 (95% CI: 0.58-0.67), respectively. For the purpose of accurately ruling out patients for 30-day MACE, a HEART score of ≤3 had a sensitivity and NPV of 99% and 98%, respectively, compared to 97% and 91%, respectively, for TIMI=0, and 94% and 85%, respectively, for GRACE ≤75. The percent of patients with 30-day MACE with HEART scores between 0 and 3, 4-6, and 7-10 was 2%, 28%, and 63%, respectively. CONCLUSION: In high acuity chest pain patients, the HEART score is superior to the TIMI and GRACE scores in predicting 30-day MACE.
BACKGROUND: The HEART, TIMI, and GRACE scores have been applied in the Emergency Department (ED) to risk stratify patients with undifferentiated chest pain. This study aims to compare the accuracy of HEART, TIMI, and GRACE for the prediction of major adverse cardiac events (MACE) in high acuity chest painpatients. METHODS: Adult patients who presented with chest pain suggestive of cardiac origin in the most acute triage category at an academic ED from September 2010 to October 2015 were included. The HEART, TIMI, and GRACE scores were calculated retrospectively from prospectively collected data. The primary outcome was occurrence of MACE (mortality, AMI, PCI, CABG) within 30-days of initial presentation. RESULTS: 604 patients were included in the study. Patient demographics include an average age of 61years, 69% male, and 48% with history of ischemic heart disease. 36% of patients met the primary outcome. The c-statistics of HEART, TIMI, and GRACE were 0.78 (95% CI: 0.74-0.81), 0.65 (95% CI: 0.60-0.69), and 0.62 (95% CI: 0.58-0.67), respectively. For the purpose of accurately ruling out patients for 30-day MACE, a HEART score of ≤3 had a sensitivity and NPV of 99% and 98%, respectively, compared to 97% and 91%, respectively, for TIMI=0, and 94% and 85%, respectively, for GRACE ≤75. The percent of patients with 30-day MACE with HEART scores between 0 and 3, 4-6, and 7-10 was 2%, 28%, and 63%, respectively. CONCLUSION: In high acuity chest painpatients, the HEART score is superior to the TIMI and GRACE scores in predicting 30-day MACE.
Authors: Salah S Al-Zaiti; Ziad Faramand; Mohammad O Alrawashdeh; Susan M Sereika; Christian Martin-Gill; Clifton Callaway Journal: Am J Emerg Med Date: 2018-06-08 Impact factor: 2.469
Authors: José Carlos Nicolau; Gilson Soares Feitosa Filho; João Luiz Petriz; Remo Holanda de Mendonça Furtado; Dalton Bertolim Précoma; Walmor Lemke; Renato Delascio Lopes; Ari Timerman; José A Marin Neto; Luiz Bezerra Neto; Bruno Ferraz de Oliveira Gomes; Eduardo Cavalcanti Lapa Santos; Leopoldo Soares Piegas; Alexandre de Matos Soeiro; Alexandre Jorge de Andrade Negri; Andre Franci; Brivaldo Markman Filho; Bruno Mendonça Baccaro; Carlos Eduardo Lucena Montenegro; Carlos Eduardo Rochitte; Carlos José Dornas Gonçalves Barbosa; Cláudio Marcelo Bittencourt das Virgens; Edson Stefanini; Euler Roberto Fernandes Manenti; Felipe Gallego Lima; Francisco das Chagas Monteiro Júnior; Harry Correa Filho; Henrique Patrus Mundim Pena; Ibraim Masciarelli Francisco Pinto; João Luiz de Alencar Araripe Falcão; Joberto Pinheiro Sena; José Maria Peixoto; Juliana Ascenção de Souza; Leonardo Sara da Silva; Lilia Nigro Maia; Louis Nakayama Ohe; Luciano Moreira Baracioli; Luís Alberto de Oliveira Dallan; Luis Augusto Palma Dallan; Luiz Alberto Piva E Mattos; Luiz Carlos Bodanese; Luiz Eduardo Fonteles Ritt; Manoel Fernandes Canesin; Marcelo Bueno da Silva Rivas; Marcelo Franken; Marcos José Gomes Magalhães; Múcio Tavares de Oliveira Júnior; Nivaldo Menezes Filgueiras Filho; Oscar Pereira Dutra; Otávio Rizzi Coelho; Paulo Ernesto Leães; Paulo Roberto Ferreira Rossi; Paulo Rogério Soares; Pedro Alves Lemos Neto; Pedro Silvio Farsky; Rafael Rebêlo C Cavalcanti; Renato Jorge Alves; Renato Abdala Karam Kalil; Roberto Esporcatte; Roberto Luiz Marino; Roberto Rocha Corrêa Veiga Giraldez; Romeu Sérgio Meneghelo; Ronaldo de Souza Leão Lima; Rui Fernando Ramos; Sandra Nivea Dos Reis Saraiva Falcão; Talia Falcão Dalçóquio; Viviana de Mello Guzzo Lemke; William Azem Chalela; Wilson Mathias Júnior Journal: Arq Bras Cardiol Date: 2021-07 Impact factor: 2.667