Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department

Background: The HEART, TIMI, and GRACE scores have been applied in the Emergency Department (ED) to risk stratify patients with undifferentiated chest pain. This study aims to compare the accuracy of HEART, TIMI, and GRACE for the prediction of major adverse cardiac events (MACE) in high acuity chest pain patients.

Methods: Adult patients who presented with chest pain suggestive of cardiac origin in the most acute triage category at an academic ED from September 2010 to October 2015 were included. The HEART, TIMI, and GRACE scores were calculated retrospectively from prospectively collected data. The primary outcome was occurrence of MACE (mortality, AMI, PCI, CABG) within 30-days of initial presentation.

Results: 604 patients were included in the study. Patient demographics include an average age of 61 years, 69% male, and 48% with history of ischemic heart disease. 36% of patients met the primary outcome. The c-statistics of HEART, TIMI, and GRACE were 0.78 (95% CI: 0.74-0.81), 0.65 (95% CI: 0.60-0.69), and 0.62 (95% CI: 0.58-0.67), respectively. For the purpose of accurately ruling out patients for 30-day MACE, a HEART score of

Conclusion: In high acuity chest pain patients, the HEART score is superior to the TIMI and GRACE scores in predicting 30-day MACE. (C) 2016 Elsevier Ireland Ltd. All rights reserved.