Why the study?
The utility of clinical risk scores for predicting major adverse cardiac events is uncertain.
Do specific clinical risk scores or integrated clinical judgement accurately predict 30-day MACE in patients presenting to the ED with suspected acute coronary syndrome?
Do specific clinical risk scores or integrated clinical judgement accurately predict 30-day MACE in patients presenting to the ED with suspected acute coronary syndrome?
The HEART score, GRACE score, T-MACS, and unstructured integrated clinical judgement perform well for predicting 30-day MACE in suspected ACS, outperforming TIMI and EDACS scores.
ICJ matched top scores for 30-day MACE prediction; leaves open whether it should guide routine ED decisions without prospective validation.
AIMS: The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician. METHODS AND RESULTS: Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study. We compared the prognostic performance of the HEART score, GRACE score, T-MACS, TIMI score, and EDACS, as well as the unstructured ICJ of the treating ED physician (visual analogue scale to estimate the probability of acute coronary syndrome, ranging from 0 to 100). Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART score, GRACE score, T-MACS, and ICJ [area under the receiver operating characteristic curve (AUC) 0.85-0.87] but significantly lower and only moderate for the TIMI score (AUC 0.79, P < 0.001) and EDACS (AUC 0.74, P < 0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93-96, 87 (P < 0.001), and 72% (P < 0.001), respectively. CONCLUSION: The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00470587.
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Meier et al. (2023) studied this question.
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