T-MACS score ≥0.229 predicted significant coronary artery stenosis with 97% sensitivity and 90% specificity, outperforming HEART and EDACS scores.
How effectively do the HEART, EDACS, and T-MACS scores predict acute coronary syndrome with significant coronary artery stenosis in patients presenting to the emergency department with chest pain?
The HEART and T-MACS scores demonstrate excellent discriminatory accuracy for predicting significant coronary artery stenosis in emergency department patients with chest pain, outperforming the EDACS score.
Tasa de eventos absoluta: 0% vs 0%
Abstract Introduction Chest pain (CP) is a common presenting symptom in emergency departments (ED), where a key task is to confirm or exclude acute coronary syndrome (ACS). Several risk stratification scoring systems have emerged, with the HEART, EDACS, and T-MACS scores being readily applicable in clinical practice. Objectives To assess the performance of the HEART, EDACS, and T-MACS scores in predicting ACS with significant coronary artery stenosis (SCS) in pts presenting with CP to the ED of a regional hospital in Portugal. Methods Retrospective single-center study of adult pts admitted to the ED with CP and classified as very urgent by the Manchester system during the first 5 months of 2022. Pts with ST-segment elevation myocardial infarction, traumatic CP or those in the postoperative period of cardiothoracic surgery were excluded. Pts with suspected ACS underwent cardiac catheterization (CC) and were classified into two groups: Group 1, consisting of pts with significant coronary artery stenosis (SCS), defined as ≥70% coronary artery stenosis; and Group 2, which included ACS patients without SCS and non-ACS patients. Demographic data were recorded, and the HEART, EDACS, and T-MACS scores were calculated for each patient. Group comparisons were performed. Results A total of 480 pts were included; median age was 59 yrs (IQR 27) and 241 pts (50.2%) were male. The baseline characteristics are presented in Table 1. 46 pts (9.6%) underwent CC due to suspected ACS, and 34 (7.1%) were found to have SCS (Group 1). Group 1 pts were significantly older and had a higher prevalence of diabetes, hypertension, dyslipidemia and history of coronary artery disease (Table 1). The EDACS score showed the lowest discriminatory capacity for ACS-SCS, with an area under the curve (AUC) of 0.846 (p0.001) and a score ≥16.5 yielding 85% sensitivity and 76% specificity. In contrast, the HEART and T-MACS scores showed superior discriminatory accuracy for ACS-SCS (AUC 0.956 and 0.947, respectively; p0.001), with a HEART score ≥6.5 yielding 82% sensitivity and 46% specificity, and a T-MACS score ≥0.229 showing 97% sensitivity and 90% specificity. However, it is important to note that both the HEART and T-MACS scores have limited discriminatory ability for predicting ACS-SCS in pts with moderate risk. Conclusions The HEART, EDACS, and T-MACS scores are valuable tools for SCS, enabling the prioritization of CP pts in ED and ensuring timely interventions and efficient resource allocation.Table 1 Figure 1
Martins et al. (Sat,) reported a other. T-MACS score ≥0.229 predicted significant coronary artery stenosis with 97% sensitivity and 90% specificity, outperforming HEART and EDACS scores.