Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department

Sakamoto, Jeffrey Tadashi; Liu, Nan; Koh, Zhi Xiong; Fung, Nicholas Xue Jin; Heldeweg, Micah Liam Arthur; Ng, Janson Cheng Ji; Ong, Marcus Eng Hock

doi:10.1016/j.ijcard.2016.07.147

Cited by 63 publications

(58 citation statements)

References 21 publications

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“…Our search identified 778 citations (Figure ) and following removal of duplicates, we screened 557 studies, from which 62 studies underwent full‐text review. We included 29 distinct cohorts from 30 studies in the meta‐analysis . All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3). Twenty‐one studies also evaluated the prognostic accuracy of the HEART score using a high‐risk threshold (score between 7 and 10) . Eight studies additionally evaluated the prognostic accuracy of a low‐risk TIMI (score of either 0 or 1) for prediction of MACE, while three evaluated the prognostic accuracy of a high‐risk TIMI (score of either 6 or 7) …”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies evaluated the HEART score for 30‐day incidence of MACE, while 13 evaluated the HEART score for 6‐week incidence of MACE . Most studies included only patients presenting with chest pain, while five studies included patients presenting with “suspected ACS.” In 14 studies, the ECG was interpreted by an ED physician, while in seven studies the ECG was specifically interpreted by a cardiologist . Four studies computed the HEART score using high‐sensitivity troponin assays, while the remaining studies used conventional troponin T or I assays (as used in the original study) …”

Section: Resultsmentioning

confidence: 99%

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Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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Objective: The HEART score has been proposed for emergency department (ED) prediction of major adverse cardiac events (MACE). We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult ED patients presenting with chest pain.Methods: We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception through May 2018 and included studies using the HEART score for the prediction of short-term MACE in adult patients presenting to the ED with chest pain. The main outcome was short-term (i.e., 30-day or 6-week) incidence of MACE. We secondarily evaluated the prognostic accuracy of the HEART score for prediction of mortality and myocardial infarction (MI). Where available, accuracy of the Thrombolysis in Myocardial Infarction (TIMI) score was determined. Results:We included 30 studies (n = 44,202) in analysis. A HEART score above the low-risk threshold (≥4) had a sensitivity of 95.9% (95% confidence interval [CI] = 93.3%-97.5%) and specificity of 44.6% (95% CI = 38.8%-50.5%) for MACE. A high-risk HEART score (≥7) had a sensitivity of 39.5% (95% CI = 31.6%-48.1%) and specificity of 95.0% (95% CI = 92.6%-96.6%) for MACE, whereas a TIMI score above the low-risk threshold (≥2) had a sensitivity of 87.8% (95% CI = 80.2%-92.8%) and specificity of 48.1% (95% CI = 38.9%-57.5%) for MACE. A high-risk TIMI score (≥6) was 2.8% sensitive (95% CI = 0.8%-9.6%), but 99.6% (95% CI = 98.5%-99.9%) specific for MACE. A HEART score ≥ 4 had a sensitivity of 95.0% (95% CI = 87.2%-98.2%) for prediction of mortality and 97.5% (95% CI = 93.7%-99.0%) for prediction of MI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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“…[9][10][11] Previous studies have indicated that the performance of the History, Electrocardiogram (ECG), Age, Risk factors, Troponin (HEART) score seems superior to other risk prediction scores. [12][13][14][15][16] It has been recommended that patients with a HEART score ≤3 should be discharged without further diagnostic testing, including no second cardiac troponin (cTn) measurement. 17,18 However, triage decisions for chest pain patients using usual care are based on a comprehensive strategy performed in the physician's mind.…”

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confidence: 99%

Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

Wang

Zheng

et al. 2019

Clinical Cardiology

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Background Triage decisions for chest pain patients receiving usual care are based on a dynamic and comprehensive strategy performed in the physician's mind. It remains controversial whether simple, structured risk tools can surpass real, complex judgments. Hypothesis The potentially used History, Electrocardiogram, Age, Risk factors, Troponin (HEART) score would help identify low‐risk patients for discharge. Methods Patients with acute, non‐traumatic chest pain managed according to usual care were consecutively enrolled in a tertiary university hospital in China from August 24, 2015 to September 30, 2017. Major adverse cardiac events (MACE) included death, acute myocardial infarction, revascularization, and significant coronary stenosis (>50%) within 30 days. We compared the efficacy and safety of usual care and the potentially used HEART score in this population. Results Of 2185 patients analyzed, 926 (42.4%) patients were directly discharged by usual care, whereas HEART≤3 would have identified 524 (24.0%) patients as low‐risk (P < .001). The MACE rate in discharged patients was 2.2% (20/926) and would have been 5.2% (27/524) in those with HEART≤3 (P = .002). For discharged patients, the MACE rates in HEART≤3 vs HEART>3 groups were not significantly different (1.5% vs 2.7%, P = .225). Negative predictive value (NPV) was higher with usual care than with the HEART score (P = .003), but sensitivity was similar. For 340 patients with serial troponins, usual care was superior to the potentially used HEART score in regard to efficacy. Conclusions At this institution, usual care identified many more patients for discharge than the HEART score would have without apparently different outcomes in discharged patients with lower vs higher HEART scores. The HEART score would not appear to provide helpful risk stratification.

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“…8 Recent studies suggest that applying the HEART score had an improved specificity and sensitivity for predicting MACE when compared to TIMI scores. 9 HEART scores of less than or equal to three outperformed TIMI scores as a low-risk threshold. 10 Those patients with the lowest HEART scores could be managed by ER staff.…”

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confidence: 88%

Getting it right the first time: Stress-only MPI in the ER

Wolinsky

2018

Journal of Nuclear Cardiology

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Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department

Cited by 63 publications

References 21 publications

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Comparison of usual care and the HEART score for effectively and safely discharging patients with low‐risk chest pain in the emergency department: would the score always help?

Getting it right the first time: Stress-only MPI in the ER

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