Comparison of three risk stratification rules for predicting patients with acute coronary syndrome presenting to an australian emergency department

Cullen, L., Greenslade, J., Hammett, C.J., Brown, A.F.T., Chew, D.P., Bilesky, J., Than, M., Lamanna, A., Ryan, K., Chu, K. and Parsonage, W.A. (2013) Comparison of three risk stratification rules for predicting patients with acute coronary syndrome presenting to an australian emergency department. Heart Lung and Circulation, 22 10: 844-851. doi:10.1016/j.hlc.2013.03.074


Author Cullen, L.
Greenslade, J.
Hammett, C.J.
Brown, A.F.T.
Chew, D.P.
Bilesky, J.
Than, M.
Lamanna, A.
Ryan, K.
Chu, K.
Parsonage, W.A.
Title Comparison of three risk stratification rules for predicting patients with acute coronary syndrome presenting to an australian emergency department
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2013-01-01
Sub-type Article (original research)
DOI 10.1016/j.hlc.2013.03.074
Volume 22
Issue 10
Start page 844
End page 851
Total pages 8
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
2740 Pulmonary and Respiratory Medicine
Abstract Objectives: To compare the predictive ability of three risk stratification tools used to assess patients presenting to the ED with potential acute coronary syndrome. Design: Pre-planned analysis of an observational study. Setting: A single tertiary referral hospital. Participants: 1495 patients presented with chest pain. 948 patients were screened and enrolled. Patients with at least 5. min of chest pain suggestive of ACS were eligible. Interventions: Subjects were risk categorised using the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines (HFA/CSANZ), the TIMI score and the GRACE score. Three strata of the TIMI and GRACE score were used to compare to the HFA/CSANZ risk categories. Main outcome measurement: 30-Day cardiac event rates including cardiac death, acute myocardial infarction and unstable angina. Results: There were 152 events in 91 patients (9.6%). The discriminatory ability of the scores determined by the AUC was 0.83 (95% CI 0.79-0.87) for the GRACE score, 0.79 (95% CI 0.74-0.83) for TIMI score and 0.75 (95% CI 0.70-0.80) for HFA/CSANZ. The AUCs with three strata of the GRACE and TIMI scores were 0.76 (95% CI 0.72-0.81) and 0.68 (95% CI 0.62-0.73) respectively. Conclusions: All three scores were similar in performance in quantifying risk in ED patients with possible ACS. The GRACE score identified a sizable low risk cohort with high sensitivity and NPV but complexity of this tool may limit its utility. Improved scores are needed to allow early identification of low- and high-risk patients to support improvements in patient flow and ED overcrowding.
Keyword Acute coronary syndrome
Chest pain
Emergency
Risk stratification
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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