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A prospective risk stratification and validation of HEART, GRACE and TIMI scores for chest pain patients presenting to the emergency department

Objective: Chest pain is amongst the most frequently occurring symptoms in patients presenting to the emergency department (ED). Accurate and fast risk stratification is paramount for identification of patients with immediate risk of acute coronary syndrome (ACS). The present study has compared different scoring systems like HEART (History, ECG, Age, Risk factors, Troponin), Thrombolysis in Myocardial Infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores and their efficacy in predicting incidence of major adverse cardiac events (MACE). Methods: The present prospective observational study was conducted on 199 patients who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores were calculated with collected patient data which was further evaluated for efficacy by calculating area under ROC curves (AUCs). Data were analyzed by using R statistical software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates statistical significance. Results: In the current study, 76 (38%) patients reported MACE. The HEART score identified the largest number of patients as high risk 74 (37%) and among them 69 patients developed a MACE. The AUC of HEART score was the highest with 0.96 (95% CI: 0.93-0.98), followed by TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75- 0.813). The sensitivity of HEART score of ≥7 for MACE was found to be 90.78%, specificity was 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value (NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPV was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was 95.96%, PPV was 82.14% and NPV was 69.18%. Conclusion: The HEART score showed higher efficacy in predicting risk levels in patients and incidence of MACE in comparison with GRACE and TIMI scores in the included study cohort.