Open AccessCOMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.
Author(s) -
Zahid Shaikh,
Varsha Shinde,
Sumalya Tripathi,
Dhiraj Ramdas Jadhav,
Ishan Lamba,
Alok Gangurde,
Kulkarni Sweta
Publication year - 2019
Publication title -
international journal of medical and biomedical studies
Language(s) - English
Resource type - Journals
eISSN - 2589-8698
pISSN - 2589-868X
DOI - 10.32553/ijmbs.v3i11.746
Subject(s) - acute coronary syndrome , medicine , chest pain , timi , framingham risk score , emergency department , observational study , risk assessment , emergency medicine , intensive care medicine , cardiology , myocardial infarction , percutaneous coronary intervention , disease , computer security , psychiatry , computer science
Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients.
We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS.
Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility.
Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS