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Meta-Analysis
. 2021 Aug 18;11(8):e048356.
doi: 10.1136/bmjopen-2020-048356.

Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

Jun Ke #  1   2 , Yiwei Chen #  3 , Xiaoping Wang  1   2 , Zhiyong Wu  4 , Feng Chen  5   6
Affiliations
Meta-Analysis

Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis

Jun Ke et al. BMJ Open. .

Abstract

Background: The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).

Methods: We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).

Results: The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.

Conclusions: TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.

Keywords: accident & emergency medicine; adult cardiology; coronary heart disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the literature search and study selection process.
Figure 2
Figure 2
QUADAS-2 scoring of included studies. QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies 2.
Figure 3
Figure 3
The summary receiver operating characteristic curve (SROC) of risk stratification assessed by the TIMI score. AUC, area under the curve; TIMI, thrombolysis in myocardial infarction.
Figure 4
Figure 4
The summary receiver operating characteristic curve (SROC) of risk stratification assessed by the HEART score. AUC, area under the curve; HEART, History, Electrocardiography, Age, Risk factors and Troponin.
Figure 5
Figure 5
The summary receiver operating characteristic curve (SROC) of risk stratification assessed by the grace score. AUC, area under the curve.
See this image and copyright information in PMC

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References

    1. Goodacre S, Cross E, Arnold J, et al. . The health care burden of acute chest pain. Heart 2005;91:229–30. 10.1136/hrt.2003.027599 - DOI - PMC - PubMed
    1. World Health Organization . Cardiovascular diseases. Available: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-disea... [Accessed June 2019].
    1. Launbjerg J, Fruergaard P, Hesse B, et al. . Long-Term risk of death, cardiac events and recurrent chest pain in patients with acute chest pain of different origin. Cardiology 1996;87:60–6. 10.1159/000177061 - DOI - PubMed
    1. Hollander JE. Risk stratification of emergency department patients with chest pain: the need for standardized reporting guidelines. Ann Emerg Med 2004;43:68–70. 10.1016/s0196-0644(03)00726-1 - DOI - PubMed
    1. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med 2000;342:1187–95. 10.1056/NEJM200004203421607 - DOI - PubMed

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