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Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome
Author(s) -
Macdonald Stephen PJ,
Nagree Yusuf,
Fatovich Daniel M,
Flavell Helen L,
Loutsky Francis
Publication year - 2011
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2011.01480.x
Subject(s) - medicine , timi , acute coronary syndrome , myocardial infarction , guideline , emergency department , framingham risk score , cardiology , thrombolysis , troponin , risk stratification , observational study , disease , pathology , psychiatry
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.