1. Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome.
- Author
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Macdonald SP, Nagree Y, Fatovich DM, Flavell HL, and Loutsky F
- Subjects
- Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome physiopathology, Aged, Australia, Biomarkers blood, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction drug therapy, Myocardial Infarction physiopathology, New Zealand, Practice Guidelines as Topic, Predictive Value of Tests, Prospective Studies, Risk Factors, Thrombolytic Therapy, Troponin blood, Acute Coronary Syndrome diagnosis, Emergency Service, Hospital, Myocardial Infarction diagnosis, Risk Assessment methods
- Abstract
Objective: To compare two methods of risk stratification for suspected acute coronary syndrome (ACS) in the ED., Methods: A prospective observational multicentre study was undertaken of patients undergoing evaluation in the ED for possible ACS. We compared the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline and the Thrombolysis in Myocardial Infarction (TIMI) risk score for differentiating high- and low-risk patients. Composite outcome was all cause death, myocardial infarction or coronary revascularisation within 30 days., Results: Of 1758 enrolments, 223 (13%) reached the study outcome. Area under the receiver operator characteristic (ROC) curve was 0.79 (95% CI 0.76-0.81) for the NHF/CSANZ group and 0.71 (0.68-0.75) for TIMI score based on initial troponin result (P<0.001), and 0.82 (95% CI 0.80-0.84) and 0.76 (0.73-0.79) respectively when the 8-12 h troponin result is included (P=0.001). Thirty day event rates were 33% for NHF/CSANZ high-risk vs 1.5% for combined low/intermediate risk (P<0.001). For TIMI score, 30 day event rates were 23% for a score ≥2 and 4.8% for TIMI<2 (P<0.001). The NHF/CSANZ guideline identified more patients as low risk compared with the TIMI risk score (61% vs 48%, P<0.001)., Conclusions: The NHF/CSANZ guideline is superior to the TIMI risk score for risk stratification of suspected ACS in the ED., (© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)
- Published
- 2011
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