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Comparing TIMI, HEART, and GRACE Risk Scores to Predict Angiographic Severity of Coronary Artery Disease and 30-Day Major Adverse Cardiac Events in Emergency Department Patients with NSTEACS

Published online by Cambridge University Press:  13 October 2023

Necmiye Yalcin Ocak Open the ORCID record for Necmiye Yalcin Ocak [Opens in a new window] ,
Murat Yesilaras Open the ORCID record for Murat Yesilaras [Opens in a new window] ,
Baris Kilicaslan Open the ORCID record for Baris Kilicaslan [Opens in a new window] ,
Yesim Eyler Open the ORCID record for Yesim Eyler [Opens in a new window] ,
İnan Mutlu Open the ORCID record for İnan Mutlu [Opens in a new window]  and
Murat Kutlu Open the ORCID record for Murat Kutlu [Opens in a new window]
Necmiye Yalcin Ocak*
Affiliation:
Emergency Physician, Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
Murat Yesilaras
Affiliation:
Emergency Physician, Assoc. Prof., Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
Baris Kilicaslan
Affiliation:
Cardiologist, Prof., Department of Cardiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
Yesim Eyler
Affiliation:
Emergency Physician, Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
İnan Mutlu
Affiliation:
Cardiologist, Assist. Prof., Department of Cardiology, Izmir Tınaztepe University, Izmir, Turkey
Murat Kutlu
Affiliation:
Emergency Physician, Ergani State Hospital, Emergency Services, Diyarbakır, Turkey
*
Correspondence: Necmiye Yalcin Ocak, MD University of Health Sciences Tepecik Training and Research Hospital Department of Emergency Medicine Gaziler Caddesi, Yenisehir, 35120, Izmir, Turkey E-mail: dr.nyalcin@gmail.com
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Abstract

Background:

Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined.

Methods:

This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients’ demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score.

Results:

The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant.

Conclusion:

The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.

Keywords

GensiniGRACEHEARTMACENSTEACSTIMI
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 6 , December 2023 , pp. 740 - 748
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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