Comparison of the HEART, TIMI and GRACE risk scores for chest pain patients at the emergency room

Background: Chest pain is a common reason for presentation at the emergency room. Absolute criteria for Acute Coronary Syndrome (ACS) without ST elevation are lacking. Recently, we introduced the HEART score, which was specifically designed to stratify patients with chest pain in the emergency room, consisting of patient History, typical ECG changes, higher Age, classical Risk factors and elevated Troponin levels (table 1). Retrospective validations have been published. The purpose of this prospective observational study was to assess the predictive value for a cardiovascular event of HEART, TIMI and GRACE risk scores for chest pain patients. Methods: A total of 2440 patients presented with chest pain during October 2008 and November 2009 at the cardiac emergency rooms of ten hospitals. HEART, TIMI and GRACE scores are calculated based on patient history, risk factors, medication, physical examination, ECG and laboratory values. The primary end point was major adverse cardiac events (MACE), a composite of Acute Myocardial Infarction (MI), Percutaneous Coronary Intervention (PCI), Coronary Artery Bypass Grafting (CABG), Significant stenosis with conservative treatment and death, within 6 weeks after presentation.