Risk prediction in patients presenting with suspected cardiac pain

The GRACE and TIMI risk scores versus clinical evaluation

G. Ramsay, M. Podogrodzka, C. McClure, K. A.A. Fox*

*Corresponding author for this work

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Identifying which patients presenting with undifferentiated chest pain are at risk of major cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected cardiac pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected cardiac pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission (n=30) within 3 months. Both GRACE (p<0.001) and TIMI scores (p<0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major cardiac events (z=2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis (p<0.001) and duration of hospital stay (p<0.001). Discussion: In unselected patients presenting with suspected cardiac pain, the GRACE risk score is superior to the TIMI risk score in predicting major cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.

Original languageEnglish
Pages (from-to)11-18
Number of pages8
JournalQJM
Volume100
Issue number1
DOIs
Publication statusPublished - 1 Jan 2007

Fingerprint

Pain
Emergencies
Myocardial Infarction
Chest Pain
ROC Curve
Myocardial Revascularization
Troponin
Teaching Hospitals
Observational Studies
Length of Stay
Electrocardiography
Outcome Assessment (Health Care)
Prospective Studies
Population

Keywords

  • myocardial infarction
  • troponin
  • chest pain
  • cardiac event
  • roc curve
  • diagnosis
  • timi grading system
  • revascularization
  • cardiac pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Risk prediction in patients presenting with suspected cardiac pain : The GRACE and TIMI risk scores versus clinical evaluation. / Ramsay, G.; Podogrodzka, M.; McClure, C.; Fox, K. A.A.

In: QJM, Vol. 100, No. 1, 01.01.2007, p. 11-18.

Research output: Contribution to journalArticle

@article{1b5653e12cc34e018abdfcf8341bb889,
title = "Risk prediction in patients presenting with suspected cardiac pain: The GRACE and TIMI risk scores versus clinical evaluation",
abstract = "Background: Identifying which patients presenting with undifferentiated chest pain are at risk of major cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected cardiac pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected cardiac pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6{\%}) experienced a major cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission (n=30) within 3 months. Both GRACE (p<0.001) and TIMI scores (p<0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major cardiac events (z=2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis (p<0.001) and duration of hospital stay (p<0.001). Discussion: In unselected patients presenting with suspected cardiac pain, the GRACE risk score is superior to the TIMI risk score in predicting major cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.",
keywords = "myocardial infarction, troponin, chest pain, cardiac event, roc curve, diagnosis, timi grading system, revascularization, cardiac pain",
author = "G. Ramsay and M. Podogrodzka and C. McClure and Fox, {K. A.A.}",
year = "2007",
month = "1",
day = "1",
doi = "10.1093/qjmed/hcl133",
language = "English",
volume = "100",
pages = "11--18",
journal = "QJM",
issn = "1460-2725",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Risk prediction in patients presenting with suspected cardiac pain

T2 - The GRACE and TIMI risk scores versus clinical evaluation

AU - Ramsay, G.

AU - Podogrodzka, M.

AU - McClure, C.

AU - Fox, K. A.A.

PY - 2007/1/1

Y1 - 2007/1/1

N2 - Background: Identifying which patients presenting with undifferentiated chest pain are at risk of major cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected cardiac pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected cardiac pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission (n=30) within 3 months. Both GRACE (p<0.001) and TIMI scores (p<0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major cardiac events (z=2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis (p<0.001) and duration of hospital stay (p<0.001). Discussion: In unselected patients presenting with suspected cardiac pain, the GRACE risk score is superior to the TIMI risk score in predicting major cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.

AB - Background: Identifying which patients presenting with undifferentiated chest pain are at risk of major cardiac events is a major clinical challenge. Clinical evaluation may lack sufficient precision, leading to unnecessary admission or inappropriate discharge. It is uncertain whether risk scores derived from ACS populations apply to unselected patients with chest pain. Aim: To determine the predictive accuracies of the GRACE risk score, the TIMI risk score and clinical evaluation in unselected patients with suspected cardiac pain. Design: Prospective observational study. Methods: We recruited 347 sequential patients with suspected cardiac pain presenting to a large teaching hospital. The main outcome measures were death, non-fatal myocardial infarction and emergency revascularization, in hospital and at 3 months. Receiver operating characteristic (ROC) curves were plotted for TIMI and GRACE risk scores and clinical evaluation. Results: Overall 54 patients (15.6%) experienced a major cardiac event (16 deaths, seven myocardial infarctions (MIs), one emergency revascularization) or emergency re-admission (n=30) within 3 months. Both GRACE (p<0.001) and TIMI scores (p<0.001) predicted death/MI/revascularization (and the composite including re-admission), but the GRACE score was superior to the TIMI score for predicting major cardiac events (z=2.05), and both scores were superior to clinical evaluation (ROC areas 0.82, 0.74 and 0.55 respectively). The GRACE score predicted an ACS discharge diagnosis (p<0.001) and duration of hospital stay (p<0.001). Discussion: In unselected patients presenting with suspected cardiac pain, the GRACE risk score is superior to the TIMI risk score in predicting major cardiac events, and both risk scores are superior to using ECG and troponin findings at presentation.

KW - myocardial infarction

KW - troponin

KW - chest pain

KW - cardiac event

KW - roc curve

KW - diagnosis

KW - timi grading system

KW - revascularization

KW - cardiac pain

UR - http://www.scopus.com/inward/record.url?scp=33845891636&partnerID=8YFLogxK

U2 - 10.1093/qjmed/hcl133

DO - 10.1093/qjmed/hcl133

M3 - Article

VL - 100

SP - 11

EP - 18

JO - QJM

JF - QJM

SN - 1460-2725

IS - 1

ER -