A prospective risk stratification and validation of HEART, GRACE and TIMI scores for chest pain patients presenting to the emergency department

Q3 Nursing

Journal of Emergency Practice and Trauma Pub Date : 2022-07-01 DOI:10.34172/jept.2022.16

Madhushri Vadhone Dinesh, A. Ramesh, Keshava Murthy M Rangaswamy, Hariprasad Kanakapura Veerendranath

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引用次数: 1

Abstract

Objective: Chest pain is amongst the most frequently occurring symptoms in patients presenting to the emergency department (ED). Accurate and fast risk stratification is paramount for identification of patients with immediate risk of acute coronary syndrome (ACS). The present study has compared different scoring systems like HEART (History, ECG, Age, Risk factors, Troponin), Thrombolysis in Myocardial Infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores and their efficacy in predicting incidence of major adverse cardiac events (MACE). Methods: The present prospective observational study was conducted on 199 patients who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores were calculated with collected patient data which was further evaluated for efficacy by calculating area under ROC curves (AUCs). Data were analyzed by using R statistical software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates statistical significance. Results: In the current study, 76 (38%) patients reported MACE. The HEART score identified the largest number of patients as high risk 74 (37%) and among them 69 patients developed a MACE. The AUC of HEART score was the highest with 0.96 (95% CI: 0.93-0.98), followed by TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75- 0.813). The sensitivity of HEART score of ≥7 for MACE was found to be 90.78%, specificity was 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value (NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPV was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was 95.96%, PPV was 82.14% and NPV was 69.18%. Conclusion: The HEART score showed higher efficacy in predicting risk levels in patients and incidence of MACE in comparison with GRACE and TIMI scores in the included study cohort.

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急诊科胸痛患者HEART、GRACE和TIMI评分的前瞻性风险分层和验证

目的：胸痛是急诊科患者最常见的症状之一。准确快速的风险分层对于识别急性冠状动脉综合征（ACS）的直接风险患者至关重要。本研究比较了不同的评分系统，如HEART（病史、心电图、年龄、危险因素、肌钙蛋白）、心肌梗死溶栓（TIMI）和急性冠状动脉事件全球登记（GRACE）评分，以及它们在预测主要心脏不良事件（MACE）发生率方面的疗效。方法：对199例急诊科胸痛患者进行前瞻性观察研究。用收集的患者数据计算HEART、GRACE和TIMI评分，通过计算ROC曲线下面积（AUCs）进一步评估疗效。使用R统计软件4.0.3版和Microsoft Excel对数据进行分析。P值小于或等于0.05表示统计学显著性。结果：在目前的研究中，76名（38%）患者报告了MACE。HEART评分确定高危患者最多的有74名（37%），其中69名患者出现MACE。HEART评分AUC最高，为0.96（95%CI:0.93-0.98），其次是TIMI评分0.815（95%CI:0.75-0.873）和GRACE评分0.814（95%CI:0.75-0.813），阳性预测值（PPV）为93.24%，阴性预测值（NPV）为94.4%。GRACE评分的敏感性为39.4%，特异性为95.16%，PPV为83.3%，NPV为71.95%，PPV为82.14%，NPV为69.18%。结论：与纳入研究队列中的GRACE和TIMI评分相比，HEART评分在预测患者风险水平和MACE发生率方面显示出更高的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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