title: Comparison of three risk stratification rules for predicting patients with acute coronary syndrome presenting to an Australian emergency department.
abstract: OBJECTIVE
  To compare the predictive ability of three risk stratification tools used to assess patients presenting to the ED with potential acute coronary syndrome.
  
  
  METHODS
  Pre-planned analysis of an observational study.
  
  
  METHODS
  A single tertiary referral hospital.
  
  
  METHODS
  1495 patients presented with chest pain. 948 patients were screened and enrolled. Patients with at least 5 min of chest pain suggestive of ACS were eligible.
  
  
  METHODS
  Subjects were risk categorised using the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines (HFA/CSANZ), the TIMI score and the GRACE score. Three strata of the TIMI and GRACE score were used to compare to the HFA/CSANZ risk categories.
  
  
  METHODS
  30-Day cardiac event rates including cardiac death, acute myocardial infarction and unstable angina.
  
  
  RESULTS
  There were 152 events in 91 patients (9.6%). The discriminatory ability of the scores determined by the AUC was 0.83 (95% CI 0.79-0.87) for the GRACE score, 0.79 (95% CI 0.74-0.83) for TIMI score and 0.75 (95% CI 0.70-0.80) for HFA/CSANZ. The AUCs with three strata of the GRACE and TIMI scores were 0.76 (95% CI 0.72-0.81) and 0.68 (95% CI 0.62-0.73) respectively.
  
  
  CONCLUSIONS
  All three scores were similar in performance in quantifying risk in ED patients with possible ACS. The GRACE score identified a sizable low risk cohort with high sensitivity and NPV but complexity of this tool may limit its utility. Improved scores are needed to allow early identification of low- and high-risk patients to support improvements in patient flow and ED overcrowding.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia. Electronic address: louise_cullen@health.qld.gov.au.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.forename: Jaimi
authors.initials: J
authors.lastname: Greenslade
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammett
authors.forename: Anthony F T
authors.initials: AF
authors.lastname: Brown
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bilesky
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.forename: Arvin
authors.initials: A
authors.lastname: Lamanna
authors.forename: Kimberley
authors.initials: K
authors.lastname: Ryan
authors.forename: Kevin
authors.initials: K
authors.lastname: Chu
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D000328:Adult; D001315:Australia; D002637:Chest Pain / Q000473:pathology / Q000503:physiopathology; D003643:Death; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Acute coronary syndrome; Chest pain; Emergency; Risk stratification