title: Inaccuracy of Thrombolysis in Myocardial Infarction and Global Registry in Acute Coronary Events scores in predicting outcome in ED patients with potential ischemic chest pain.
abstract: OBJECTIVE
  The Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry in Acute Coronary Events (GRACE) scores were largely evaluated and validated in stratifying risk of cardiovascular events in patients with chest pain and acute coronary syndrome. Our objective was to compare these 2 scores in predicting outcome in emergency department (ED) patients with undifferentiated chest pain.
  
  
  METHODS
  This was a prospective cohort study including patients presenting to 4 EDs with chest pain with nondiagnostic or normal ECG. For all included patients (n = 3125), TIMI and GRACE scores were calculated. Follow-up was conducted at 30-day and 1-year post-ED index admission to identify major adverse events. Main outcome included all cause mortality, acute coronary syndrome, and coronary non-ED planned revascularization. Prognostic performance of the scores was assessed by the receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  We reported 285 (9.1%) major adverse events at 30 days and 436 (13.9%) at 1 year. In patients with low TIMI (≤2) and GRACE (<109) scores, a significant proportion had major adverse events at 30 days (5% and 7.5%, respectively) and 1 year (7.9% and 12.9%, respectively). Area under ROC curve at 30 days was 0.66 (95% confidence interval [CI], 0.62-0.71) vs 0.57 (95% CI, 0.53-0.62), respectively, for TIMI and GRACE scores. At 1 year, the area under ROC was 0.67 (95% CI, 0.62-0.71) and 0.65 (95% CI, 0.60-0.70), respectively, for TIMI and GRACE scores.
  
  
  CONCLUSIONS
  The TIMI and GRACE scores are not valid in short- and long-term risk stratification in our chest pain patients.
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Boubaker
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Kaouther
authors.initials: K
authors.lastname: Beltaief
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Mohamed Habib
authors.initials: MH
authors.lastname: Grissa
authors.affiliation: Emergency Department, Tahar Sfar University Hospital, Mahdia Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Wièm
authors.initials: W
authors.lastname: Kerkeni
authors.affiliation: Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
authors.forename: Zohra
authors.initials: Z
authors.lastname: Dridi
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Mohamed Amine
authors.initials: MA
authors.lastname: Msolli
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Hamdène
authors.initials: H
authors.lastname: Chouchène
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Alia
authors.initials: A
authors.lastname: Belaïd
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Hamadi
authors.initials: H
authors.lastname: Chouchène
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sassi
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Wahid
authors.initials: W
authors.lastname: Bouida
authors.affiliation: Emergency Department, Sahloul University Hospital, Sousse, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Riadh
authors.initials: R
authors.lastname: Boukef
authors.affiliation: Emergency Department, Farhat Hached Hospital, Sousse, Tunisia.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Methemmem
authors.affiliation: Emergency Department, Tahar Sfar University Hospital, Mahdia Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia.
authors.forename: Soudani
authors.initials: S
authors.lastname: Marghli
authors.affiliation: Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia; Research Laboratory (LR12SP18), University of Monastir Tunisia, Monastir, Tunisia. Electronic address: Semir.nouira@rns.tn.
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods* / Q000592:standards*; D014218:Triage / Q000379:methods; D014416:Tunisia