TY - JOUR
T1 - Comparison of the HEART and TIMI risk scores for suspected acute coronary syndrome in the emergency department
AU - Sun, Benjamin C.
AU - Laurie, Amber
AU - Fu, Rongwei
AU - Ferencik, Maros
AU - Shapiro, Michael
AU - Lindsell, Christopher J.
AU - Diercks, Deborah
AU - Hoekstra, James W.
AU - Hollander, Judd E.
AU - Kirk, J. Douglas
AU - Peacock, W. Frank
AU - Anantharaman, Venkataraman
AU - Pollack, Charles V.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Objectives: The emergency department evaluation for suspected acute coronary syndrome (AC S) is common, costly, and challenging. Risk scores may help standardize clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TIMI) and HEART are two commonly cited risk scores. We tested the null hypothesis that the TIMI and HEART risk scores have equivalent test characteristics. Methods: We analyzed data from the Internet Tracking Registry of Acute Coronary Syndromes (i∗TrAC S) from 9 EDs on patients with suspected AC S, 1999-2001. We excluded patients with an emergency department diagnosis consistent with AC S, or without sufficient data to calculate TIMI and HEART scores. The primary outcome was 30-day major adverse cardiovascular events, including all-cause death, acute myocardial infarction, and urgent revascularization. We describe test characteristics of the TIMI and HEART risk scores. Results: The study cohort included 8255 patients with 508 (6.2%) 30-day major adverse cardiovascular events. Receiver operating curve and reclassification analyses favored HEART [c statistic: 0.753, 95% confidence interval (CI): 0.733-0.773; continuous net reclassification improvement: 0.608, 95% CI: 0.527-0.689] over TIMI (c statistic: 0.678, 95% CI: 0.655-0.702). A HEART score 0-3 [negative predictive value (NPV) 0.982, 95% CI: 0.978-0.986; positive predictive value (PPV) 0.103, 95% CI: 0.094-0.113; likelihood ratio (LR) positive 1.76; LR negative 0.28] demonstrates similar or superior NPV/PPV/LR compared with TIMI = 0 (NPV 0.978, 95% CI: 0.971-0.983; PPV 0.077, 95% CI: 0.071-0.084; LR positive 1.28; LR negative 0.35) and TIMI = 0-1 (NPV 0.963, 95% CI: 0.958-0.968; PPV 0.102, 95% CI: 0.092-0.113; LR positive 1.73; LR negative 0.58). Conclusions: The HEART score has better discrimination than TIMI and outperforms TIMI within previously published "low-risk" categories.
AB - Objectives: The emergency department evaluation for suspected acute coronary syndrome (AC S) is common, costly, and challenging. Risk scores may help standardize clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TIMI) and HEART are two commonly cited risk scores. We tested the null hypothesis that the TIMI and HEART risk scores have equivalent test characteristics. Methods: We analyzed data from the Internet Tracking Registry of Acute Coronary Syndromes (i∗TrAC S) from 9 EDs on patients with suspected AC S, 1999-2001. We excluded patients with an emergency department diagnosis consistent with AC S, or without sufficient data to calculate TIMI and HEART scores. The primary outcome was 30-day major adverse cardiovascular events, including all-cause death, acute myocardial infarction, and urgent revascularization. We describe test characteristics of the TIMI and HEART risk scores. Results: The study cohort included 8255 patients with 508 (6.2%) 30-day major adverse cardiovascular events. Receiver operating curve and reclassification analyses favored HEART [c statistic: 0.753, 95% confidence interval (CI): 0.733-0.773; continuous net reclassification improvement: 0.608, 95% CI: 0.527-0.689] over TIMI (c statistic: 0.678, 95% CI: 0.655-0.702). A HEART score 0-3 [negative predictive value (NPV) 0.982, 95% CI: 0.978-0.986; positive predictive value (PPV) 0.103, 95% CI: 0.094-0.113; likelihood ratio (LR) positive 1.76; LR negative 0.28] demonstrates similar or superior NPV/PPV/LR compared with TIMI = 0 (NPV 0.978, 95% CI: 0.971-0.983; PPV 0.077, 95% CI: 0.071-0.084; LR positive 1.28; LR negative 0.35) and TIMI = 0-1 (NPV 0.963, 95% CI: 0.958-0.968; PPV 0.102, 95% CI: 0.092-0.113; LR positive 1.73; LR negative 0.58). Conclusions: The HEART score has better discrimination than TIMI and outperforms TIMI within previously published "low-risk" categories.
KW - HEART score
KW - Risk score
KW - TIMI
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U2 - 10.1097/HPC.0000000000000066
DO - 10.1097/HPC.0000000000000066
M3 - Article
C2 - 26881812
AN - SCOPUS:84959369611
SN - 1535-282X
VL - 15
SP - 1
EP - 5
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
IS - 1
ER -