Risk stratifying chest pain patients in the emergency department using HEART, GRACE and TIMI scores, with a single contemporary troponin result, to predict major adverse cardiac events

Abstract

HEART outperformed both TIMI and GRACE in overall discriminative capacity for 30-day MACE. Using a single contemporary cTn at presentation, a HEART score of ≤3 demonstrated sensitivity and NPV of ≥99.5% for 30-day MACE. These results reach the threshold for a safe discharge strategy but should be interpreted thoughtfully in light of other work.

Evaluation and comparison of six GRACE models for the stratification of undifferentiated chest pain in the emergency department

“…In our previous report, the HEART score would not appear to provide additionally helpful risk stratification to the usual care for discharging low-risk patients [36]. Regarding the high-risk category, HEART ≥7 did not perform as well (specificity 87.0%; PPV 53.4%) as in Reaney's study [16].…”

“…The Global Registry of Acute Coronary Events (GRACE) score is an objective prediction tool for definite acute coronary syndrome (ACS), incorporating age, vital signs, kidney function, ECG and troponin levels [9]. This tool has been validated for risk stratification of individuals with acute chest pain [10][11][12][13][14][15][16][17]. In particular, the 0 h/3 h algorithm with the GRACE score incorporated into is recommended (Class I, Level B) for risk stratification and rule-out of AMI in patients with suspected non-ST-elevation ACS by 2015 European Society of Cardiology (ESC) guideline [6].…”

“…The GRACE models have been compared with other scores for stratifying undifferentiated chest pain, such as the History, ECG, Age, Risk Factors, and Troponin (HEART) score and the Thrombolysis in Myocardial Infarction (TIMI) score [21,22]. Generally, GRACE was inferior to the HEART score, and the most common GRACE score applied was the one for predicting in-hospital death [11][12][13][14][15][16]. The questions of why this model is selected and whether it is the most appropriate one remain unanswered.…”

Evaluation and comparison of six GRACE models for the stratification of undifferentiated chest pain in the emergency department

“…The Global Registry of Acute Coronary Events (GRACE) score is an objective prediction tool for definite acute coronary syndrome (ACS), incorporating age, vital signs, kidney function, ECG and troponin levels [9]. This tool has been validated for risk stratification of individuals with acute chest pain [10][11][12][13][14][15][16][17]. In particular, the 0 h/3 h algorithm with the GRACE score incorporated into is recommended (Class I, Level B) for risk stratification and rule-out of AMI in patients with suspected non-ST-elevation ACS by 2015 European Society of Cardiology (ESC) guideline [6].…”

Role of High-sensitivity Cardiac Troponin in Acute Coronary Syndrome

“…A few studies have examined the use of EKG, hscTn, and clinical risk prediction scores at some centers. [35][36][37][38][39][40] Most of these covered accelerated diagnostic protocols combining some risk scores, most commonly…”