Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

Abstract

BackgroundThe study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).MethodsWe systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).ResultsThe pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.ConclusionsTIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.

Predictive Value of the HEART Score Combined with Hypersensitive C-Reactive Protein for 30 d Adverse Cardiovascular Events in Patients with Acute Chest Pain

“…The HEART score is a nonspecific scoring system that does not require inclusion or exclusion criteria for patients with chest pain, and the items of the score are easy to collect data and less difficult to calculate, which facilitates daily use by clinical workers [ 16 ]. Unlike other chest pain scoring systems, the HEART score includes patient history, ECG, age, risk factors, and troponin levels, emphasizing the combination of ECG and troponin levels, which is more accurate than conventional assessment methods [ 17 ]. At the same time, the HEART score assesses different independent risk components in patients with acute chest pain without the need for clear evidence of acute coronary syndromes and can identify patients' condition and prognosis as soon as possible [ 18 ].…”

Risk Prediction Models for Ischemic Cardiovascular Outcomes in Patients with Acute Coronary Syndrome

“…The variables included in these two scoring systems are mainly derived from the data and electrocardiogram (ECG) that are easily available in the emergency room. These indicators are good at predicting shortterm prognosis and long-term major adverse cardiovascular events (MACE) [24][25][26][27]. It has been suggested to use a modified TIMI score (mTIMI, range 0-10) which gives some variables more weight.…”

A Closer Look at the HEART Score

“…To date, however, there have been a few meta-analyses performed on HEART score [5][6][7]. Van Den Berg et al reported the results of their meta-analysis on two prospective and 10 retrospective cohort studies, in which the HEART score was found to be valuable in identifying subgroups with and without subsequent MACE among patients with acute chest pain [5].…”

“…Van Den Berg et al reported the results of their meta-analysis on two prospective and 10 retrospective cohort studies, in which the HEART score was found to be valuable in identifying subgroups with and without subsequent MACE among patients with acute chest pain [ 5 ]. More recently Ke et al [ 6 ] also published results of their meta-analysis using pooled data from all available prospective cohort studies on predictive abilities of TIMI, HEART and GRACE scores up to June 2020. The data on HEART score from 16 studies were included in their analysis.…”