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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
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,...
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Published in: | Prehospital and disaster medicine 2023-12, Vol.38 (6), p.740-748 |
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description | 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.
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.
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.
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. |
doi_str_mv | 10.1017/S1049023X23006490 |
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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.
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.
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.</description><identifier>ISSN: 1049-023X</identifier><identifier>EISSN: 1945-1938</identifier><identifier>DOI: 10.1017/S1049023X23006490</identifier><identifier>PMID: 37830209</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Acute Coronary Syndrome - diagnostic imaging ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Adult ; Age ; Aged ; Angina pectoris ; Angioplasty ; Antidiabetics ; Blood pressure ; Cardiology ; Cardiovascular disease ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - therapy ; Coronary vessels ; Creatinine ; Diabetes ; Electrocardiography ; Emergency medical care ; Emergency Service, Hospital ; Family medical history ; Female ; Heart attacks ; Heart surgery ; High density lipoprotein ; Hospitals ; Humans ; Hypertension ; Male ; Medicine ; Middle Aged ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Original Research ; Pain ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Registries ; Risk Assessment ; Risk Factors ; Vein & artery diseases ; Vital signs</subject><ispartof>Prehospital and disaster medicine, 2023-12, Vol.38 (6), p.740-748</ispartof><rights>The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c325t-dc3147b956433827a1ea0f20f3a756b618a3265dbefe0f2ab31b15ff6892591d3</cites><orcidid>0000-0003-0071-7813 ; 0000-0002-4024-7900 ; 0000-0001-8956-2111 ; 0000-0002-1465-8263 ; 0000-0002-2357-1274 ; 0000-0003-1503-7554</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1049023X23006490/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,72960</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37830209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yalcin Ocak, Necmiye</creatorcontrib><creatorcontrib>Yesilaras, Murat</creatorcontrib><creatorcontrib>Kilicaslan, Baris</creatorcontrib><creatorcontrib>Eyler, Yesim</creatorcontrib><creatorcontrib>Mutlu, İnan</creatorcontrib><creatorcontrib>Kutlu, Murat</creatorcontrib><title>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</title><title>Prehospital and disaster medicine</title><addtitle>Prehosp. Disaster med</addtitle><description>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.
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.
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.
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.</description><subject>Acute Coronary Syndrome - diagnostic imaging</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Angina pectoris</subject><subject>Angioplasty</subject><subject>Antidiabetics</subject><subject>Blood pressure</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Cholesterol</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary vessels</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Electrocardiography</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Family medical history</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart surgery</subject><subject>High density lipoprotein</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Original Research</subject><subject>Pain</subject><subject>Percutaneous Coronary Intervention</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Vein & artery diseases</subject><subject>Vital signs</subject><issn>1049-023X</issn><issn>1945-1938</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kc9u1DAQxiMEoqXwAFzQSFw4NOA_cZwcozS0K7VQbRaJW-Qkk9TLJt7a3qJ9OZ4Nt11AAnGakb_f983IE0WvKXlPCZUfakqSnDD-lXFC0tA-iY5pnoiY5jx7Gvogx_f6UfTCuTUhLBcsfR4dcZlxwkh-HP0ozbRVVs8jrBZXi1O4qIrl6hTU3MP5sigrWGr3DerOWHTgDVxb7HXnoZhHbUartje6gxrv0Gq_BzNAaayZld1DYT2GcqYdKocPiZzEZ2oPV2ptLBR9MAWhVLbXqoPqDmfvQM9QTWhHnLtgxrCcn4IA18rrB-C79jfwqV5VRVm_jJ4NauPw1aGeRF8-VqvyIr78fL4oi8u440z4uO84TWSbizThPGNSUVRkYGTgSoq0TWmmOEtF3-KA4V21nLZUDEOa5UzktOcn0bvH3K01tzt0vpm063CzUTOanWtYJiXPJONJQN_-ha7Nzs5hu0DlkmVCcBIo-kh11jhncWi2Vk_h2xpKmvvjNv8cN3jeHJJ37YT9b8evawaAH0LV1Frdj_hn9v9jfwIAo61C</recordid><startdate>202312</startdate><enddate>202312</enddate><creator>Yalcin Ocak, Necmiye</creator><creator>Yesilaras, Murat</creator><creator>Kilicaslan, Baris</creator><creator>Eyler, Yesim</creator><creator>Mutlu, İnan</creator><creator>Kutlu, Murat</creator><general>Cambridge University Press</general><general>Jems Publishing Company, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0071-7813</orcidid><orcidid>https://orcid.org/0000-0002-4024-7900</orcidid><orcidid>https://orcid.org/0000-0001-8956-2111</orcidid><orcidid>https://orcid.org/0000-0002-1465-8263</orcidid><orcidid>https://orcid.org/0000-0002-2357-1274</orcidid><orcidid>https://orcid.org/0000-0003-1503-7554</orcidid></search><sort><creationdate>202312</creationdate><title>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</title><author>Yalcin Ocak, Necmiye ; Yesilaras, Murat ; Kilicaslan, Baris ; Eyler, Yesim ; Mutlu, İnan ; Kutlu, Murat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c325t-dc3147b956433827a1ea0f20f3a756b618a3265dbefe0f2ab31b15ff6892591d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Coronary Syndrome - diagnostic imaging</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Angina pectoris</topic><topic>Angioplasty</topic><topic>Antidiabetics</topic><topic>Blood pressure</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Cholesterol</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary vessels</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Electrocardiography</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Family medical history</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart surgery</topic><topic>High density lipoprotein</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Original Research</topic><topic>Pain</topic><topic>Percutaneous Coronary Intervention</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Vein & artery diseases</topic><topic>Vital signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yalcin Ocak, Necmiye</creatorcontrib><creatorcontrib>Yesilaras, Murat</creatorcontrib><creatorcontrib>Kilicaslan, Baris</creatorcontrib><creatorcontrib>Eyler, Yesim</creatorcontrib><creatorcontrib>Mutlu, İnan</creatorcontrib><creatorcontrib>Kutlu, Murat</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Prehospital and disaster medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yalcin Ocak, Necmiye</au><au>Yesilaras, Murat</au><au>Kilicaslan, Baris</au><au>Eyler, Yesim</au><au>Mutlu, İnan</au><au>Kutlu, Murat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Prehospital and disaster medicine</jtitle><addtitle>Prehosp. Disaster med</addtitle><date>2023-12</date><risdate>2023</risdate><volume>38</volume><issue>6</issue><spage>740</spage><epage>748</epage><pages>740-748</pages><issn>1049-023X</issn><eissn>1945-1938</eissn><abstract>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.
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.
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.
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.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>37830209</pmid><doi>10.1017/S1049023X23006490</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0071-7813</orcidid><orcidid>https://orcid.org/0000-0002-4024-7900</orcidid><orcidid>https://orcid.org/0000-0001-8956-2111</orcidid><orcidid>https://orcid.org/0000-0002-1465-8263</orcidid><orcidid>https://orcid.org/0000-0002-2357-1274</orcidid><orcidid>https://orcid.org/0000-0003-1503-7554</orcidid></addata></record> |
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subjects | Acute Coronary Syndrome - diagnostic imaging Acute Coronary Syndrome - therapy Acute coronary syndromes Adult Age Aged Angina pectoris Angioplasty Antidiabetics Blood pressure Cardiology Cardiovascular disease Cholesterol Coronary Angiography Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - therapy Coronary vessels Creatinine Diabetes Electrocardiography Emergency medical care Emergency Service, Hospital Family medical history Female Heart attacks Heart surgery High density lipoprotein Hospitals Humans Hypertension Male Medicine Middle Aged Myocardial infarction Myocardial Infarction - diagnosis Original Research Pain Percutaneous Coronary Intervention Prognosis Prospective Studies Registries Risk Assessment Risk Factors Vein & artery diseases Vital signs |
title | 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 |
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