Document Type : Original Article
Authors
- Madhushri Vadhone Dinesh 1, 2
- Aruna Chala Ramesh 2
- Keshava Murthy M Rangaswamy 2
- Hariprasad Kanakapura Veerendranath 2
1 Department of Emergency Medicine, Basaveshwara Medical College and Hospital, Rajiv Gandhi University of Health Science (RGUHS), Bangalore, Karnataka, India
2 Department of Emergency Medicine, Ramaiah Medical College, Rajiv Gandhi University of Health Science (RGUHS), Bangalore, Karnataka, India
Abstract
Objective: Chest pain is amongst the most frequently occurring symptoms in patients
presenting to the emergency department (ED). Accurate and fast risk stratification is
paramountforidentification 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), andGlobal
RegistryofAcuteCoronaryEvents(GRACE)scores andtheir efficacyinpredicting incidence
of major adverse cardiac events(MACE).
Methods: The present prospective observational study was conducted on 199 patients
who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores
were calculated with collected patient data which was further evaluated for efficacy by
calculating area under ROC curves (AUCs). Data were analyzed by using R statistical
software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates
statistical significance.
Results:Inthecurrentstudy,76(38%)patientsreportedMACE.TheHEARTscoreidentified
thelargestnumberofpatientsashighrisk74(37%)andamongthem69patientsdeveloped
aMACE.TheAUCofHEART scorewasthehighestwith0.96(95%CI:0.93-0.98),followedby
TIMIscore 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%,specificity
was 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%, PPV
was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was
95.96%, PPV was 82.14% and NPV was 69.18%.
Conclusion:TheHEARTscoreshowedhigherefficacyinpredictingrisklevelsinpatientsand
incidenceofMACE incomparisonwithGRACE andTIMIscoresintheincludedstudy cohort.
Keywords
Main Subjects
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