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Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome.
MedLine Citation:
PMID:  22151670     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Stephen Pj Macdonald; Yusuf Nagree; Daniel M Fatovich; Helen L Flavell; Francis Loutsky
Publication Detail:
Type:  Journal Article     Date:  2011-08-30
Journal Detail:
Title:  Emergency medicine Australasia : EMA     Volume:  23     ISSN:  1742-6723     ISO Abbreviation:  Emerg Med Australas     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101199824     Medline TA:  Emerg Med Australas     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  717-25     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Affiliation:
Emergency Department, Armadale Health Service Discipline of Emergency Medicine, University of Western Australia Emergency Department, Royal Perth Hospital Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research Emergency Department, Rockingham General Hospital Emergency Department, Fremantle Hospital, Fremantle, Western Australia, Australia.
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