Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome
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/C...
| Main Authors: | , , , , |
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| Format: | Journal Article |
| Published: |
2011
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| Online Access: | http://hdl.handle.net/20.500.11937/39209 |
| _version_ | 1848755529432694784 |
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| author | MacDonald, S. Nagree, Y. Fatovich, D. Flavell, Helen Loutsky, F. |
| author_facet | MacDonald, S. Nagree, Y. Fatovich, D. Flavell, Helen Loutsky, F. |
| author_sort | MacDonald, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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 8-12h 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. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. |
| first_indexed | 2025-11-14T08:57:45Z |
| format | Journal Article |
| id | curtin-20.500.11937-39209 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T08:57:45Z |
| publishDate | 2011 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-392092017-09-13T14:23:34Z Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome MacDonald, S. Nagree, Y. Fatovich, D. Flavell, Helen Loutsky, F. 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 8-12h 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. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. 2011 Journal Article http://hdl.handle.net/20.500.11937/39209 10.1111/j.1742-6723.2011.01480.x restricted |
| spellingShingle | MacDonald, S. Nagree, Y. Fatovich, D. Flavell, Helen Loutsky, F. Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title | Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title_full | Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title_fullStr | Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title_full_unstemmed | Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title_short | Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| title_sort | comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome |
| url | http://hdl.handle.net/20.500.11937/39209 |