Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome
Betsy Lee1, Anna Marie Chang, Asako C Matsuura
1Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
Insights
The TIMI risk score demonstrated superior ability in predicting 30-day cardiovascular events for emergency department patients with potential acute coronary syndrome (ACS). This finding supports its use in risk stratification for ACS in the ED.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Risk Stratification
Background:
- Accurate risk stratification of emergency department (ED) patients with potential acute coronary syndrome (ACS) is crucial for timely intervention.
- Existing risk scores for ACS have varying utility in the broader ED population presenting with potential ACS.
Purpose of the Study:
- To compare the prognostic value of the GRACE and PURSUIT risk scores against the TIMI risk score in a large cohort of ED patients with potential ACS.
- To evaluate the discriminatory ability of these risk scores in predicting 30-day adverse cardiovascular events.
Main Methods:
- Secondary analysis of a prospective cohort study including 4743 ED patients with potential ACS.
- Data collection included demographics, medical history, and components of TIMI, GRACE, and PURSUIT scores.
- 30-day composite outcome: death, nonfatal myocardial infarction, or revascularization. Receiver operating characteristic (ROC) curves were used for comparison.
Main Results:
- The TIMI risk score showed the highest area under the curve (AUC) at 0.757 (95% CI: 0.728-0.785).
- The GRACE risk score had an AUC of 0.728 (95% CI: 0.701-0.755), and the PURSUIT risk score had an AUC of 0.691 (95% CI: 0.662-0.720).
- The TIMI score demonstrated better predictive performance compared to GRACE and PURSUIT in this population.
Conclusions:
- The TIMI risk score exhibited the best discriminatory ability for predicting 30-day cardiovascular events in emergency department patients with potential ACS.
- These findings highlight the utility of the TIMI score for risk stratification in this critical patient group.
- Further validation in diverse populations may be warranted.
Objective:
: The ability to risk stratify patients presenting to the emergency department (ED) with potential acute coronary syndrome (ACS) is critical. Several risk scores for patients with definite ACS have been developed, but only the TIMI risk score has been shown to risk stratify ED patients with potential ACS. We compared the prognostic value of the GRACE and PURSUIT risk scores to the TIMI score in the broader ED patient population presenting with potential ACS.
Methods:
: We performed a secondary analysis of a prospective cohort study that enrolled patients who presented to the ED with potential ACS. Demographics, history, and components of the TIMI, GRACE, and PURSUIT scores were obtained. Follow-up was conducted by structured record review and phone. The main outcome was a composite of 30-day death, nonfatal acute myocardial infarction, and revascularization. The GRACE scores ranged from 0 to 330 and PURSUIT scores ranged from 0 to 18 and were subsequently divided into 8 equivalent strata to correspond with TIMI score range and to facilitate comparison. For each of the 3 risk scores, receiver operating characteristic (ROC) curves were used to compare prediction of 30-day event rates.
Results:
: There were 4743 patients enrolled (mean age: 52.5 ± 13.3; 56% female; 65% black). By 30 days, there were 59 deaths, 172 acute myocardial infarctions, and 175 revascularizations. The area under the curve for TIMI was 0.757 (95% CI: 0.728-0.785); GRACE, 0.728 (95% CI: 0.701-0.755); and PURSUIT, 0.691 (95% CI: 0.662-0.720).
Conclusion:
: In this large cohort of ED patients, the TIMI risk score had the best discriminatory ability to predict 30-day cardiovascular events.
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