Key result
The NHF/CSANZ guideline was superior to the TIMI risk score for risk stratification of suspected ACS in the emergency department (AUC 0.79 vs 0.71; P<0.001).
Why the study?
Does the NHF/CSANZ guideline improve risk stratification compared to the TIMI risk score in patients with suspected ACS in the emergency department?
Observational (n=1,758)
Yes
Does the NHF/CSANZ guideline improve risk stratification compared to the TIMI risk score in patients with suspected ACS in the emergency department?
Effect estimate: AUC 0.79 (95% CI 0.76-0.81)
p-value: p=<0.001
The NHF/CSANZ guideline provides superior risk stratification for suspected ACS in the emergency department compared to the TIMI risk score, accurately identifying more patients as low risk.
May support NHF/CSANZ over TIMI for ED risk stratification in suspected ACS; leaves open whether adoption improves outcomes.
OBJECTIVE: To compare two methods of risk stratification for suspected acute coronary syndrome (ACS) in the ED. METHODS: A prospective observational multicentre study was undertaken of patients undergoing evaluation in the ED for possible ACS. We compared the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline and the Thrombolysis in Myocardial Infarction (TIMI) risk score for differentiating high- and low-risk patients. Composite outcome was all cause death, myocardial infarction or coronary revascularisation within 30 days. RESULTS: Of 1758 enrolments, 223 (13%) reached the study outcome. Area under the receiver operator characteristic (ROC) curve was 0.79 (95% CI 0.76-0.81) for the NHF/CSANZ group and 0.71 (0.68-0.75) for TIMI score based on initial troponin result (P<0.001), and 0.82 (95% CI 0.80-0.84) and 0.76 (0.73-0.79) respectively when the 8-12 h troponin result is included (P=0.001). Thirty day event rates were 33% for NHF/CSANZ high-risk vs 1.5% for combined low/intermediate risk (P<0.001). For TIMI score, 30 day event rates were 23% for a score ≥2 and 4.8% for TIMI<2 (P<0.001). The NHF/CSANZ guideline identified more patients as low risk compared with the TIMI risk score (61% vs 48%, P<0.001). CONCLUSIONS: The NHF/CSANZ guideline is superior to the TIMI risk score for risk stratification of suspected ACS in the ED.
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Macdonald et al. (2011) conducted an observational in Suspected acute coronary syndrome (ACS) (n=1,758). NHF/CSANZ guideline vs. TIMI risk score was evaluated on Composite of all cause death, myocardial infarction or coronary revascularisation within 30 days (AUC 0.79, 95% CI 0.76-0.81, p=<0.001). The NHF/CSANZ guideline was superior to the TIMI risk score for risk stratification of suspected ACS in the emergency department (AUC 0.79 vs 0.71; P<0.001).
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