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Review
. 2023 Jul 19;11(1):e50.
doi: 10.22037/aaem.v11i1.2001. eCollection 2023.

HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis

Ali Kabiri  1 , Pantea Gharin  1 , Seyed Ali Forouzannia  2 , Koohyar Ahmadzadeh  1 , Reza Miri  3 , Mahmoud Yousefifard  3   1
Affiliations
Review

HEART versus GRACE Score in Predicting the Outcomes of Patients with Acute Coronary Syndrome; a Systematic Review and Meta-Analysis

Ali Kabiri et al. Arch Acad Emerg Med. .

Abstract

Introduction: Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.

Method: The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.

Results: 25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.

Conclusion: The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.

Keywords: Acute coronary syndrome; decision tools; risk assessment; sensitivity; specificity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram
Figure 2
Figure 2
Performance of GRACE score with cut-off values of ≤ 100 (a) and > 100 (b) and HEART score with cut-off values < 4 (c), equal to 4 (d) and greater than 4 (e) in the prediction of major adverse cardiovascular events
Figure 3
Figure 3
Performance of GRACE score (a) and HEART score (b) in the prediction of acute myocardial infarction
Figure 4
Figure 4
Performance of GRACE score (a) and HEART score (b) in the prediction of all-cause mortality
Figure 5
Figure 5
Publication bias of the included articles for the value of GRACE (a) and HEART (b) in the prediction of major adverse cardiovascular events
See this image and copyright information in PMC

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