HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and
Ali Kabiri1, Pantea Gharin1, Seyed Ali Forouzannia2
1Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
The Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores show low specificity for predicting major adverse cardiovascular events (MACE) and acute myocardial infarction (AMI) in acute coronary syndrome (ACS) patients. However, their high sensitivity makes them useful for ruling out adverse outcomes in low-risk ACS patients.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Systematic Review and Meta-Analysis
Background:
- Ischemic heart disease management relies on accurate outcome prediction.
- Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are common risk stratification tools for acute coronary syndrome (ACS).
- Comparative analysis of GRACE and HEART scores for ACS patient outcomes is crucial.
Purpose of the Study:
- To systematically review and meta-analyze the predictive value of GRACE and HEART scores in ACS patients.
- To compare the performance of GRACE and HEART scores in predicting major adverse cardiovascular events (MACE), acute myocardial infarction (AMI), and all-cause mortality.
- To evaluate the utility of these scores as risk assessment tools in ACS.
Main Methods:
- Systematic search of Medline, Embase, Web of Science, and Scopus databases until September 2022.
- Inclusion of studies directly comparing GRACE and HEART scores for ACS outcome prediction.
- Categorization of GRACE score cut-offs (≤100 and >100) and HEART score cut-offs (<4, =4, and >4).
- Analysis of sensitivity and specificity for predicting MACE, AMI, and all-cause mortality.
Main Results:
- 25 articles were included in the meta-analysis.
- Both GRACE and HEART scores demonstrated low specificity for predicting MACE and AMI across various cut-offs.
- High sensitivity was observed for both scores in predicting MACE and AMI.
- Neither score proved to be a suitable predictor of all-cause mortality.
Conclusions:
- GRACE and HEART scores exhibit low specificity but acceptable sensitivity for predicting MACE and AMI in ACS patients.
- These scores are more effective as 'rule-out' tools to identify low-risk ACS patients.
- Further research may be needed to refine risk prediction models for ACS, particularly for all-cause mortality.
Introduction:
Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.
Method:
The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.
Results:
25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.
Conclusion:
The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.
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