Os Escores HEART, TIMI e GRACE para Predição de Eventos Cardiovasculares Adversos Maiores no Período de 30 Dias na Era de Troponina I de Alta Sensibilidade

Abstract

Background: Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective: To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods: HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results: A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion: The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients.

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

“…Risk stratification by the TIMI score was available in 25 studies published between 2005 and 2020, 16 studies used the HEART score and were published between 2013 and 2020 and and 16 studies employed GRACE and were published between 2007 and 2020. 55 The definition of MACEs across included studies contained all-cause death, cardiac death, myocardial infarction, revascularisation, cardiac arrest, cardiogenic shock, unstable angina, ACS, percutaneous coronary intervention, coronary artery bypass grafting, coronary angiography revealing procedurally correctable stenosis managed conservatively, ventricular arrhythmia needing intervention, high-degree atrioventricular block needing intervention and life-threatening arrhythmias requiring emergency intervention. The study quality of the included studies was assessed by QUADAS-2 ( figure 2 ).…”

Pharmacological Approach for Symptomatic Nonsustained Ventricular Tachycardia

“…The TIMI scale is useful non-ST-elevation myocardial infarction (NSTEMI) risk stratification score for patients with high-risk mortality at 14 days. However, a recent study found that the HEART score was more effective than the TIMI risk score in predicting MACE at 30 days in Hispanic patients (Torralba et al., 2020). The patient also had a pulmonary embolism rule-out criteria (PERC) score of 1 given his age; nonetheless, he had no significant clinical signs and symptoms of an acute pulmonary embolism with a very low pretest probability (based on provider clinical judgment) requiring immediate imaging.…”

Machine learning for predicting intrahospital mortality in ST-elevation myocardial infarction patients with type 2 diabetes mellitus

“…Traditional models, such as the GRACE score based on clinical data and the TIMI score based on coronary angiography information, have been used to predict patient outcomes [ 12 , 13 ]. However, the performance of these scores in prognosis prediction has certain limitations, and there is a risk of delayed scoring.…”