Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study

Leung, Yuk-ki; Cheng, Nga-man; Chan, Cangel Pui-yee; Lee, Anna; Wong, Jonathan; Yan, Bryan Ping-Yen; Ahuja, Anil T.; Graham, Colin A.; Rainer, Timothy

doi:10.1016/j.jemermed.2017.05.006

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…A repeated study (Class III) in Hong Kong, showed that with a high-sensitivity troponin T test, a TIMI score cutoff of zero had 100% sensitivity [95% CI 91.6% to 100%] for predicting 30-day MACE. 42 The lower limit of the CI was low even though the sample size was good, at 602 subjects.…”

Section: Timi Scorementioning

confidence: 95%

“…61 The risk score assigns 1 point for each of 7 predictors, allowing stratification for prognosis based on score (variables include age, risk factors, history of coronary stenosis, severe angina, ST-segment elevation, recent aspirin use, and elevated biomarkers). 61 There were 2 Class I, 17,18 2 Class II, 19,20 and 16 Class III 24,25,[27][28][29][30][31][32][33]35,36,[38][39][40][41][42] studies that included performance data for TIMI score in ED patients with chest pain for predicting who would subsequently develop MACE (Table 1). Most of these studies used a cutoff score of zero as the threshold for defining low risk.…”

Section: Timi Scorementioning

confidence: 99%

“…But using a HEART score cutoff of greater than 5 led to poor sensitivity (48.9%), with specificity 83.7%. A repeated study 42 (Class III) in Hong Kong showed that a highsensitivity troponin T test along with a modified HEART score at a cutoff of less than or equal to 2 had 100% sensitivity (95% CI 91.6% to 100%) for predicting 30-day MACE. The HEART score had a single modification: the presence of ST deviation greater than 0.05 mV was scored at 1 point, rather than 2, although specificity was still poor, at 17%.…”

Section: Heart Scorementioning

confidence: 99%

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Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

Nestler¹,

Sudhir²,

Brown³

et al. 2018

Annals of Emergency Medicine

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Section: Timi Scorementioning

confidence: 95%

Section: Timi Scorementioning

confidence: 99%

Section: Heart Scorementioning

confidence: 99%

See 1 more Smart Citation

Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

Nestler¹,

Sudhir²,

Brown³

et al. 2018

Annals of Emergency Medicine

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“…Several large studies have been published beyond the search window of the May 2017 review, including at least one randomised trial and multiple prospective observational studies [ 17 , 25 – 27 ]. Nine of the 11 studies included in this review were retrospective in nature.…”

Section: Introductionmentioning

confidence: 99%

The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

et al. 2018

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BackgroundAcute coronary syndrome (ACS) is a common, sometimes difficult to diagnose spectrum of diseases occurring after abrupt reduction in blood flow through a coronary artery. Given the diagnostic challenge, it is sensible for emergency physicians to have an approach to prognosticate patients with possible ACS. Multiple prediction models have been developed to help identify patients at increased risk of adverse outcomes. The HEART score is the first model to be derived, validated, and undergo clinical impact studies in emergency department (ED) patients with possible ACS.ObjectiveTo develop a protocol for a prognostic systematic review of the literature evaluating the HEART score as a predictor of major adverse cardiac events (MACE) in patients presenting to the ED with possible ACS.Methods/designThis protocol is reported according to the PRISMA-P statement and is registered on PROSPERO. All methodological tools to be used are endorsed by the Cochrane Prognosis Methods Group. Pre-defined eligibility criteria are provided. Multiple strategies will be used to identify potentially relevant studies. Studies will be selected and data extracted using standardised forms based on the CHARMS checklist. The QUIPS tool will be used to assess the risk of bias within individual studies. Outcome measures will include prevalence, risk ratio, and absolute risk reduction for MACE within 6 weeks of ED evaluation, comparing HEART scores 0–3 versus 4–10. HEART score prognostic performance will be evaluated with the concordance (C) statistic (model discrimination), observed to expected events ratio (model calibration), and a decision curve analysis. Reporting biases and methodological, clinical, and statistical heterogeneity will be scrutinised. Unless deemed inappropriate, a meta-analysis and pre-defined subgroup and sensitivity analyses will be performed. Overall judgements about evidence quality and strength of recommendations will be summarised using the GRADE approach.DiscussionThis review will identify, select, and appraise studies evaluating the prognostic performance of the HEART score, producing results of interest to emergency physicians. These results may encourage shared clinical decision-making in the ED by facilitating risk communication with patients and health care providers.Systematic review registrationPROSPERO 2017 CRD42017084400.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0816-4) contains supplementary material, which is available to authorized users.

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“… 36 Leung et al indicated that a modified TIMI score of 0 could not rule out 30-day MACEs in ACP patients admitted to the ED. 45 The potential reasons for this could be that the TIMI score was designed for risk stratification in patients with non-ST-segment elevation ACS, which is mainly based on appropriate ECG changes or elevations of biomarkers of necrosis. Moreover, the presentation characteristics in ACP patients were not entered into the TIMI score.…”

Section: Discussionmentioning

confidence: 99%

Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

chen

Wang

et al. 2021

BMJ Open

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BackgroundThe study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).MethodsWe systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).ResultsThe pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.ConclusionsTIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.

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Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study

Abstract: A modified TIMI score of 0 or a HEART score of ≤ 2, incorporating a single hs-cTnT level, will identify patients with low risk of 30-day MACE for early discharge within 2 h of ED arrival.

Cited by 8 publications

References 27 publications

Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

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