Investigation of the effectiveness of the Quick Sequential Organ Failure Assessment-Troponin scores in non- ST-elevation myocardial infarction

Abstract

Chest pain constitutes a significant portion of all emergency department (ED) admissions 1 . Approximately 5-20% of patients who enter the ED with chest pain (typical or atypical) are diagnosed with acute coronary syndrome (ACS) 2 . This syndrome is one of the leading causes of death 3 . Even in ACS patients with timely medical intervention, 1-year mortality is 5%, and in-hospital mortality is 7.5% 4 . Approximately 70% of all ACS present as non-STEMI (ST-elevation myocardial infarction) 5 . The international cardiac guidelines recommend that patients presenting to the ED with chest pain should be evaluated using a risk score 6 . A frequently used and high-performing tool for this purpose is the Global Registry of Acute Coronary Events (GRACE) 7 . The GRACE identifies risk factors that help independently predict in-hospital and 6-month mortality rates. The score is calculated based on clinical parameters such as creatinine, troponin value, Killip class, and vital signs. The Quick Sequential Organ Failure Assessment (qSOFA) tool was developed to predict the prognosis and need for intensive care in sepsis patients. The qSOFA measurement is a simple score composed of three parameters, i.e., respiratory rate, Glasgow Coma Scale, and blood pressure 8 . Many studies have shown that the qSOFA score can be used to predict the need for intensive care and the probability of mortality 9 . Serum cardiac troponins are used to verify a diagnosis of ACS and predict its prognosis 10 . But a more reliable predictor is needed for ACS patients with high mortality risk. Therefore, we investigated the prognostic accuracy of the qSOFA score by adding cTnI concentration (as a fourth parameter). The aim of this study was to assess the effectiveness of the GRACE and qSOFA-T scores on in-hospital mortality rate in non-STEMI patients. METHODSThis study was conducted retrospectively between January 1, 2016, and December 31, 2018, on patients over the age of 18 years who were admitted to the ED. All patients who presented to the ED with ACS were evaluated consecutively (symptoms