Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome

Betsy Lee, Anna Marie Chang, Asako C. Matsuura, Shannon Marcoon, Judd E. Hollander

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)64-68
Number of pages5
JournalCritical Pathways in Cardiology
Volume10
Issue number2
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Acute Coronary Syndrome
Hospital Emergency Service
Myocardial Infarction
Myocardial Revascularization
ROC Curve
Area Under Curve
Cohort Studies
History
Demography
Prospective Studies
Population

Keywords

  • chest pain
  • emergency department
  • GRACE risk score
  • PURSUIT risk score
  • risk stratification
  • TIMI risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome. / Lee, Betsy; Chang, Anna Marie; Matsuura, Asako C.; Marcoon, Shannon; Hollander, Judd E.

In: Critical Pathways in Cardiology, Vol. 10, No. 2, 06.2011, p. 64-68.

Research output: Contribution to journalArticle

Lee, Betsy ; Chang, Anna Marie ; Matsuura, Asako C. ; Marcoon, Shannon ; Hollander, Judd E. / Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome. In: Critical Pathways in Cardiology. 2011 ; Vol. 10, No. 2. pp. 64-68.
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