The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain
- 25 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Internal and Emergency Medicine
- Vol. 16 (1), 193-200
- https://doi.org/10.1007/s11739-020-02378-0
Abstract
The history, electrocardiogram, age, risk factors, troponin (HEART) and global registry of acute coronary events (GRACE) scoring systems are commonly used to risk stratify patients with chest pain. This study investigated the application of these scores in predicting the short-term risk of a major adverse cardiac event (MACE) in patients with chest. A total of 509 patients were analyzed. All patients were followed up for 30 days after visiting our emergency department. At 30 days post-admission, the primary outcome (MACE) was recorded in 92 patients (18.1%), 88 (95.6%) of whom had experienced an acute myocardial infarction. Thirty-seven (40.2%) of the patients with a MACE underwent percutaneous coronary intervention and six patients (6.5%) died. The HEART and GRACE scores were both significantly higher in patients who developed a MACE than in those without (P < 0.05). The HEART and GRACE scores had c-statistic values of 0.811 (95% CI 0.774–0.844) and 0.648 (95% CI 0.603–0.688), respectively. The Hosmer–Lemeshow statistic revealed that the HEART and GRACE scores had values of 8.68 (P = 0.39) and 10.45 (P = 0.11), respectively. The percentages of patients with HEART scores of 0–3, 4–6, and 7–10 were 3.0%, 26.2%, and 46.3%, respectively, in those with a MACE within 30 days. The findings show that while both scoring systems are useful, the HEART score is superior to the GRACE score for predicting the occurrence of MACE within 30 days in patients with chest pain.Funding Information
- National Natural Scientific Foundation of China (81670220, 31270992, and 30800215)
This publication has 17 references indexed in Scilit:
- Rapid Evaluation of Chest Pain in the Emergency DepartmentJAMA Internal Medicine, 2014
- A prospective validation of the HEART score for chest pain patients at the emergency departmentInternational Journal of Cardiology, 2013
- Comparison of Three Risk Stratification Rules for Predicting Patients With Acute Coronary Syndrome Presenting to an Australian Emergency DepartmentHeart, Lung and Circulation, 2013
- The HEART Score for the Assessment of Patients With Chest Pain in the Emergency DepartmentCritical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2013
- Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unitThe American Journal of Emergency Medicine, 2013
- Identifying patients for early discharge: Performance of decision rules among patients with acute chest painInternational Journal of Cardiology, 2012
- Can the HEART Score Safely Reduce Stress Testing and Cardiac Imaging in Patients at Low Risk for Major Adverse Cardiac Events?Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2011
- Chest Pain in the Emergency RoomCritical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 2010
- A comparison between B-type natriuretic peptide, Global Registry of Acute Coronary Events (GRACE) score and their combination in ACS risk stratificationHeart, 2009
- Evaluation of the Patient with Acute Chest PainThe New England Journal of Medicine, 2000