Aprospective risk stratification and validation of HEART,GRACE andTIMIscoresfor chestpainpatients presenting to the emergency department

Chest pain is amongst the most frequently occurring symptoms in patientspresenting to the emergency department (ED). Accurate and fast risk stratification isparamountforidentification of patients with immediate risk of acute coronary syndrome(ACS). The present study has compared different scoring systems like HEART (History,ECG,Age,Risk factors, Troponin), ThrombolysisinMyocardial Infarction (TIMI), andGlobalRegistryofAcuteCoronaryEvents(GRACE)scores andtheir efficacyinpredicting incidenceof major adverse cardiac events(MACE).

The present prospective observational study was conducted on 199 patientswho presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scoreswere calculated with collected patient data which was further evaluated for efficacy bycalculating area under ROC curves (AUCs). Data were analyzed by using R statisticalsoftware version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicatesstatistical significance.

Inthecurrentstudy,76 (38%) patientsreported MACE.The HEART scoreidentifiedthelargestnumberofpatientsashighrisk74(37%) andamong them 69patientsdevelopedaMACE.TheAUCofHEART score wasthehighest with .96(95%CI:0.93-0.98),followedby TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75-0.813). The sensitivity of HEART score of ≥7 for MACE wasfound to be 90.78%,specificitywas 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value(NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPVwas 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was95.96%, PPV was 82.14% and NPV was 69.18%.

TheHEARTscoreshowedhigherefficacyinpredictingrisklevelsinpatientsandincidenceofMACE incomparisonwithGRACE andTIMIscoresintheincludedstudy cohort.