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

Abstract

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.

Predictive Value of the HEART Score Combined with Hypersensitive C-Reactive Protein for 30 d Adverse Cardiovascular Events in Patients with Acute Chest Pain

“…The HEART score is a nonspecific scoring system that does not require inclusion or exclusion criteria for patients with chest pain, and the items of the score are easy to collect data and less difficult to calculate, which facilitates daily use by clinical workers [ 16 ]. Unlike other chest pain scoring systems, the HEART score includes patient history, ECG, age, risk factors, and troponin levels, emphasizing the combination of ECG and troponin levels, which is more accurate than conventional assessment methods [ 17 ]. At the same time, the HEART score assesses different independent risk components in patients with acute chest pain without the need for clear evidence of acute coronary syndromes and can identify patients' condition and prognosis as soon as possible [ 18 ].…”

A Closer Look at the HEART Score

“…To date, however, there have been a few meta-analyses performed on HEART score [5][6][7]. Van Den Berg et al reported the results of their meta-analysis on two prospective and 10 retrospective cohort studies, in which the HEART score was found to be valuable in identifying subgroups with and without subsequent MACE among patients with acute chest pain [5].…”

“…Van Den Berg et al reported the results of their meta-analysis on two prospective and 10 retrospective cohort studies, in which the HEART score was found to be valuable in identifying subgroups with and without subsequent MACE among patients with acute chest pain [ 5 ]. More recently Ke et al [ 6 ] also published results of their meta-analysis using pooled data from all available prospective cohort studies on predictive abilities of TIMI, HEART and GRACE scores up to June 2020. The data on HEART score from 16 studies were included in their analysis.…”

ChatGPT provides inconsistent risk-stratification of patients with atraumatic chest pain

“…Although the TIMI score was initially designed for patients with a clinical diagnosis of UA or NSTEMI receiving anticoagulation, it has subsequently been shown to predict 30-day to 6-week major adverse cardiac events (MACE) in ED patients with atraumatic chest pain of suspected cardiac origin [ 19 , 20 ]. MACE was defined as acute MI, coronary revascularization, or death from any cause.…”

“…Another protocol for acute non-traumatic chest pain is the HEART score [ 21 ], a five-item tool initially derived from a small patient cohort in the ED to predict MACE over three months. Subsequent studies have confirmed the HEART score as a robust predictor of 1-month to six-week MACE risk [ 19 , 20 , 22 , 23 ], with scores less than or equal to 3 identifying a low-risk group with about a 2% incidence of MACE. Despite their utility, these tools have faced scrutiny regarding their sensitivity, particularly in the case of TIMI [ 24 , 25 ].…”