Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation

Ramsay, Gillian; Podogrodzka, M.; McClure, Candace; Fox, Keith A.A.

doi:10.1093/qjmed/hcl133

Cited by 109 publications

(78 citation statements)

References 21 publications

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“…Several risk scores have been developed, including Thrombolysis in Myocardial Infarction (TIMI); [4][5][6] Global Registry of Acute Coronary Events (GRACE); [7][8][9][10] Fast Revascularisation in Instability in Coronary disease (FRISC); 11 and History, ECG, Age, Risk factors, and Troponin (HEART), 12,13 to identify which patients with chest pain of cardiac etiology are at higher risk for worse cardiovascular outcomes and mortality. These scores are derived from overlapping clinical variables recorded at time of evaluation, including age, vital signs, comorbidities, and biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Shah

Marston

Müeller

et al. 2015

Academic Emergency Medicine

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Objectives: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).Methods: This was a subanalysis of the CHOPIN study, a 16-center prospective trial that enrolled 2,071 patients presenting with chest pain within 6 hours of onset. The primary endpoint was 6-month all-cause mortality and the secondary endpoint was 30-day and 6-month MACE: ED visits or hospitalization for acute myocardial infarction, unstable angina, reinfarction, revascularization, and heart failure.Results: MR-proADM performed similarly to troponin (cTnI; c-statistic = 0.845 and 0.794, respectively) for mortality prediction in all subjects and had similar results in those with noncardiac diagnoses. MRproADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.

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Section: Discussionmentioning

confidence: 99%

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Shah

Marston

Müeller

et al. 2015

Academic Emergency Medicine

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“…In the past years, several multivariate algorithms have been developed in patients with CP for estimating the need of intensive care [3,[5][6][7]31,32]. However, those studies were performed before troponin testing was routinely available, thus including patients considered at high risk, per se, to date.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, we recognized that these patients were heterogeneous; in fact, they presented with different clinical risk profiles, based on both clinical presentation and the presence of cardiovascular risk factors, and, finally, showed different outcomes. Previous risk models well stratified the overall population of patients with CP at hospital admission; however, they appeared complex to be integrated in clinical practice [3,[5][6][7]32,33].…”

Section: Discussionmentioning

confidence: 99%

A new simple risk score in patients with acute chest pain without existing known coronary disease

Conti

Vanni

Taglia

et al. 2010

The American Journal of Emergency Medicine

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Objective: To derive and validate a prediction rule in patients with acute chest pain (CP) without existing known coronary disease. Methods: Cohort study including 2233 patients with CP. Based on clinical judgment, 1435 were discharged as very low risk and the remaining 798 underwent exercise tolerance test (ETT). End point: 6-month composite of cardiovascular death, nonfatal myocardial infarction, and revascularization. The prediction rule was derived from a randomly selected test cohort (n = 1106) summing factors of variables selected by multivariate regression analysis: CP score higher than 6 (factor of 3), male gender, age older than 50 years, metabolic syndrome, and diabetes mellitus (factor of 1, for each). The prediction rule was validated in the remaining cohort (n = 1127). All patients with CP were categorized into 3 groups: group A (prediction rule 0-1), B (2-4), or C (5-6). Outcomes and prognostic yield of ETT were compared among each group. Results: In the test cohort, 55 patients (5%) reached the composite end point. Event rate increased as the prediction rule increased: 1% for group A, 6% for B, and 25% for C (P b .001). This pattern was confirmed in the validation cohort (P b .001). A normal ETT did not significantly improve the high (99%) negative predictive value in group A and did not succeed in excluding the composite end point (17%) in group C. Conclusions: In patients with acute CP without existing coronary disease, a prediction rule based on clinical characteristics provided a useful method for prognostication with possible implication in decision making.

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“…Indeed, low-risk patients represented a large and heterogeneous population with a low prevalence of coronary disease, and they presented different cardiovascular risk factors and clinical pattern and finally showed different outcomes. In this subset of patients, some risk scores allowed estimation for the need of intensive care [22,23]. Other models of risk scores well stratified the overall population of patients with CP [24,25]; however, they could not be easily integrated in clinical practice because of their complexity [24,25].…”

Section: Strengths Of Present Studymentioning

confidence: 99%

“…Other models of risk scores well stratified the overall population of patients with CP [24,25]; however, they could not be easily integrated in clinical practice because of their complexity [24,25]. Other risk scores are specific in the prognostic evaluation of patients with a definite acute coronary syndrome [6][7][8][9][10]23]. The simplicity of the novel FPR is caused by the few variables considered and to the relevance given to clinical characteristics of CP at presentation.…”

Section: Strengths Of Present Studymentioning

confidence: 99%

Risk scores prognostic implementation in patients with chest pain and nondiagnostic electrocardiograms

Conti

Poggioni

Viviani

et al. 2012

The American Journal of Emergency Medicine

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Background: Several risk scores are available for prognostic purpose in patients presenting with chest pain. Aim: The aim of this study was to compare Grace, Pursuit, Thrombolysis in Myocardial Infarction (TIMI), Goldman, Sanchis, and Florence Prediction Rule (FPR) to exercise electrocardiogram (ECG), decision making, and outcome in the emergency setting. Methods: Patients with nondiagnostic ECGs and normal troponins and without history of coronary disease underwent exercise ECG. Patients with positive testing underwent coronary angiography; otherwise, they were discharged.End point was the composite of coronary stenosis at angiography or cardiovascular death, myocardial infarction, angina, and revascularization at 12-month follow-up. Results: Of 508 patients considered, 320 had no history of coronary disease: 29 were unable to perform exercise testing, and finally, 291 were enrolled. Areas under the receiver operating characteristic curves for Grace, Pursuit, TIMI, Goldman, Sanchis, and FPR were 0.59, 0.68, 0.69, 0.543, 0.66, and 0.74, respectively (P b .05 FPR vs Goldman and Grace). In patients with negative exercise ECG and overall low risk score, only the FPR effectively succeeded in recognizing those who achieved the end point; in patients with high risk score, the additional presence of carotid stenosis and recurrent angina predicted the end point (odds ratio, 12 and 5, respectively). Overall, logistic regression analysis including exercise ECG, coronary risk factors, and risk scores showed that exercise ECG was an independent predictor of coronary events (P b .001). Conclusions: The FPR effectively succeeds in ruling out coronary events in patients categorized with overall low risk score. Exercise ECG, nonetheless being an independent predictor of coronary events could be considered questionable in this subset of patients.

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Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation

Abstract: 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.

Cited by 109 publications

References 21 publications

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

Midregional Proadrenomedullin Predicts Mortality and Major Adverse Cardiac Events in Patients Presenting With Chest Pain: Results From the CHOPIN Trial

A new simple risk score in patients with acute chest pain without existing known coronary disease

Risk scores prognostic implementation in patients with chest pain and nondiagnostic electrocardiograms

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