Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome
Authors' conclusion
The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE
Study context
- Population
- Patients presenting to the emergency department (ED) with acute chest discomfort (suspected ACS)
- Participants
- 4,551 eligible patients
- Comparison
- HEART score, GRACE score, T-MACS, TIMI score, EDACS and unstructured integrated clinical judgement (ICJ) of the treating ED physician
- Outcome
- Prognostic performance for MACE:
- All-cause death
- Life-threatening arrhythmia
- Cardiogenic shock
- Acute MI incl. index event
- Unstable angina requiring urgent coronary revascularization
- Follow-up
- 30 days
Methodological detailsinternational multicentre, central adjudication by two independent cardiologists
- International multicentre
- Central adjudication by two independent cardiologists
Performance
As reported in the abstract
Prognostic accuracy for 30-day MACE
| Test or model | AUC | Sensitivity for rule-out |
|---|---|---|
| TIMI | 0.79 | 87 |
| EDACS | 0.74 | 72% |
AUC
TIMI0.79
EDACS0.74
Sensitivity for rule-out
TIMI87
EDACS72%
- AUC for HEART, GRACE, T-MACS and ICJ: high and comparable
- 0.85-0.87
- Sensitivity for rule-out of 30-day major adverse cardiac events (MACE) for HEART, GRACE, T-MACS and ICJ
- 93-96
- TIMI AUC significantly lower
- P < 0.001
- EDACS AUC significantly lower
- P < 0.001
- TIMI sensitivity lower
- P < 0.001
- EDACS sensitivity lower
- P < 0.001
Further findings
Patients with ≥1 MACE · 30 days
- Patients with at least one MACE
- 1110/4551 (24.4%)
Original publication
Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. Published 12 July 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →