Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region
Abstract Acute non-traumatic chest pain (ANTCP) is the second cause of consultation in the Emergency department (ED). About 70% of all Acute Myocardial Infarctions present as non persistent ST-elevation acute coronary syndrome (NSTE-ACS) in the electrocardiogram. Our aim was to compare whether the H...
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| Format: | Article |
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Nature Portfolio
2023-10-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-44214-3 |
| _version_ | 1827711260871884800 |
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| author | Iris N. San Román Arispe Joaquim Sol Ana Celma Gil Javier Trujillano Marta Ortega Bravo Oriol Yuguero Torres |
| author_facet | Iris N. San Román Arispe Joaquim Sol Ana Celma Gil Javier Trujillano Marta Ortega Bravo Oriol Yuguero Torres |
| author_sort | Iris N. San Román Arispe |
| collection | DOAJ |
| description | Abstract Acute non-traumatic chest pain (ANTCP) is the second cause of consultation in the Emergency department (ED). About 70% of all Acute Myocardial Infarctions present as non persistent ST-elevation acute coronary syndrome (NSTE-ACS) in the electrocardiogram. Our aim was to compare whether the HEART risk score is more effective than the GRACE and TIMI scores for the diagnosis and prognosis of Major Adverse Cardiac Events (MACE) at six weeks in patients with ANTCP and NSTE-ACS. A prospective cohort study was conducted with patients with ANTCP that attended an ED and a Primary Care Emergency Center (PCEC) from April 2018 to December 2020. The primary outcome was MACE at six weeks. Diagnostic performance was calculated for each scale as the Area under the Receiver Operating Characteristic (ROC) curve (AUC), sensitivity (SE), specificity (SP), and predictive values (PV). Qualitative variables were compared using the Chi-square test, and continuous variables were compared using the nonparametric Kruskal–Wallis test. We adjusted a logistic regression for risk groups, age, and gender to determine the effect of the HEART, GRACE, and TIMI scores on MACE. The degree of agreement (kappa index) was calculated in the categorical classification of patients according to the three risk scales. Cox proportional hazards regressions were performed for each scale and were compared using partial likelihood ratio tests for non-nested models. From a sample of 317 patients with ANTCP, 14.82% had MACE at six weeks. The AUC was 0.743 (95% CI 0.67–0.81) for the HEART score, 0.717 (95% CI 0.64–0.79) for the TIMI score, and 0.649 (95% CI 0.561–0.738) for the GRACE score. The HEART scale identified low-risk patients with a higher SE and negative PV than the GRACE and TIMI scores. The HEART scale was better than the GRACE and TIMI scores at diagnosing and predicting MACE at six weeks in patients with ANTCP and probable NSTE-ACS. It was also a reliable tool for risk stratification in low-risk patients. Its application is feasible in EDs and PCECs, avoiding the need for complementary tests and their associated costs without compromising patient health. |
| first_indexed | 2024-03-10T17:51:13Z |
| format | Article |
| id | doaj.art-c3254e3c3a414ab8af4b8b8f1dc4804a |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-10T17:51:13Z |
| publishDate | 2023-10-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-c3254e3c3a414ab8af4b8b8f1dc4804a2023-11-20T09:21:10ZengNature PortfolioScientific Reports2045-23222023-10-0113111110.1038/s41598-023-44214-3Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care regionIris N. San Román Arispe0Joaquim Sol1Ana Celma Gil2Javier Trujillano3Marta Ortega Bravo4Oriol Yuguero Torres5Centre d’ Urgències en AtencióPrimària. InstitutCatalà de La Salut (ICS)Atenció Primària, Institut Català de La SalutCentre d’ Urgències en AtencióPrimària. InstitutCatalà de La Salut (ICS) Intensive Care Department, Hospital Universitari Arnau de VilanovaMultidisciplinary Research Group in Primary Care Therapeutics and Interventions (RETICAP), Fundació Institut Universitari per a La Recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol)Medicine and Surgery Department, Universidad de LleidaAbstract Acute non-traumatic chest pain (ANTCP) is the second cause of consultation in the Emergency department (ED). About 70% of all Acute Myocardial Infarctions present as non persistent ST-elevation acute coronary syndrome (NSTE-ACS) in the electrocardiogram. Our aim was to compare whether the HEART risk score is more effective than the GRACE and TIMI scores for the diagnosis and prognosis of Major Adverse Cardiac Events (MACE) at six weeks in patients with ANTCP and NSTE-ACS. A prospective cohort study was conducted with patients with ANTCP that attended an ED and a Primary Care Emergency Center (PCEC) from April 2018 to December 2020. The primary outcome was MACE at six weeks. Diagnostic performance was calculated for each scale as the Area under the Receiver Operating Characteristic (ROC) curve (AUC), sensitivity (SE), specificity (SP), and predictive values (PV). Qualitative variables were compared using the Chi-square test, and continuous variables were compared using the nonparametric Kruskal–Wallis test. We adjusted a logistic regression for risk groups, age, and gender to determine the effect of the HEART, GRACE, and TIMI scores on MACE. The degree of agreement (kappa index) was calculated in the categorical classification of patients according to the three risk scales. Cox proportional hazards regressions were performed for each scale and were compared using partial likelihood ratio tests for non-nested models. From a sample of 317 patients with ANTCP, 14.82% had MACE at six weeks. The AUC was 0.743 (95% CI 0.67–0.81) for the HEART score, 0.717 (95% CI 0.64–0.79) for the TIMI score, and 0.649 (95% CI 0.561–0.738) for the GRACE score. The HEART scale identified low-risk patients with a higher SE and negative PV than the GRACE and TIMI scores. The HEART scale was better than the GRACE and TIMI scores at diagnosing and predicting MACE at six weeks in patients with ANTCP and probable NSTE-ACS. It was also a reliable tool for risk stratification in low-risk patients. Its application is feasible in EDs and PCECs, avoiding the need for complementary tests and their associated costs without compromising patient health.https://doi.org/10.1038/s41598-023-44214-3 |
| spellingShingle | Iris N. San Román Arispe Joaquim Sol Ana Celma Gil Javier Trujillano Marta Ortega Bravo Oriol Yuguero Torres Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region Scientific Reports |
| title | Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region |
| title_full | Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region |
| title_fullStr | Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region |
| title_full_unstemmed | Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region |
| title_short | Comparison of heart, grace and TIMI scores to predict major adverse cardiac events from chest pain in a Spanish health care region |
| title_sort | comparison of heart grace and timi scores to predict major adverse cardiac events from chest pain in a spanish health care region |
| url | https://doi.org/10.1038/s41598-023-44214-3 |
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