Aprospective risk stratification and validation of HEART,GRACE andTIMIscoresfor chestpainpatients presenting to the emergency department

Objective: Chest pain is amongst the most frequently occurring symptoms in patientspresenting to the emergency department (ED). Accurate and fast risk stratification isparamountforidentification 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), ThrombolysisinMyocardial Infarction (TIMI), andGlobalRegistryofAcuteCoronaryEvents(GRACE)scores andtheir efficacyinpredicting incidenceof major adverse cardiac events(MACE).Methods: The present prospective observational study was conducted on ۱۹۹ patientswho presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scoreswere calculated with collected patient data which was further evaluated for efficacy bycalculating area under ROC curves (AUCs). Data were analyzed by using R statisticalsoftware version ۴.۰.۳ and Microsoft Excel. P value less than or equal to ۰.۰۵ indicatesstatistical significance.Results:Inthecurrentstudy,۷۶(۳۸%)patientsreportedMACE.TheHEARTscoreidentifiedthelargestnumberofpatientsashighrisk۷۴(۳۷%)andamongthem۶۹patientsdevelopedaMACE.TheAUCofHEART scorewasthehighestwith۰.۹۶(۹۵%CI:۰.۹۳-۰.۹۸),followedbyTIMIscore with ۰.۸۱۵ (۹۵% CI: ۰.۷۵-۰.۸۷۳) and the GRACE score with ۰.۸۱۴ (۹۵% CI: ۰.۷۵-۰.۸۱۳). The sensitivity of HEART score of ≥۷ for MACE wasfound to be ۹۰.۷۸%,specificitywas ۹۵.۹۶%, positive predictive value (PPV) was ۹۳.۲۴% and negative predictive value(NPV) was ۹۴.۴%. The sensitivity of GRACE score was ۳۹.۴%, specificity was ۹۵.۱۶%, PPVwas ۸۳.۳% and NPV was ۷۱.۹۵%. The sensitivity of TIMI score was ۳۰.۲%, specificity was۹۵.۹۶%, PPV was ۸۲.۱۴% and NPV was ۶۹.۱۸%.Conclusion:TheHEARTscoreshowedhigherefficacyinpredictingrisklevelsinpatientsandincidenceofMACE incomparisonwithGRACE andTIMIscoresintheincludedstudy cohort.

کلیدواژه ها:

Acute coronary syndrome ، Cardiovascular Diseases ، Chest pain ، Emergency Service ، risk assessment