A Comparison of the TIMI, GRACE and HEART Scores

Study Overview
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Brief Summary
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Various elements of patient history are checked and entered in the admission Case Recor Form (CRF). Three risk scores are calculated out of these elements, combined with physical examination, laboratory values and ECG-findings. The primary aim is to assess the positive and negative predictive values for a cardiovascular event of the three risk scores for chest pain patients. Secondary aim is to assess the sensitivity and specificity of various elements in the patient history for an acute coronary syndrome.

Detailed Description
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This is a prospective, observational study in patients admitted to the emergency room for chest pain. All patients are checked by the resident in charge immediately on admission, before any lab values are known, by means of an admission Case Report Form (CRF), consisting of classical elements of patient history, risk factors, medication and physical examination. This CRF is filled out immediately by the resident. No additional effort will be asked of the patients. Patient data during a follow up of at least 6 weeks are gathered from hospital charts. The predictive value of the three scoring systems: HEART (History, ECG, Age, Risk factors, Troponin), TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) for both the discharge diagnosis and the occurrence of Major Adverse Cardiovascular Events (MACE) is calculated. The primary hypothesis of the study is that the HEART score is a significantly better predictor than the TIMI and/or GRACE score for cardiovascular events during a six week period following admission to the emergency room.

Official Title
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A Prospective Comparison of the TIMI, GRACE and HEART Scores for Predicting Cardiovascular Events in Chest Pain Patients in the Emergency Room

Conditions
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Acute Coronary Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any patient visiting the cardiology emergency room due to chest pain Exclusion Criteria: chest pain clearly due to rhythm disturbances or acute heart failure concomitant non cardiac disease with expected fatal outcome within 1 year
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study Group<br>All included patients presented with chest pain at the emergency room within the inclusion period. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurence of MACE (Major Adverse Cardiac Events) | The number of patients diagnosed with MACE (Acute Myocardial Infarction, Percutaneous Coronary Intervention, Coronary Artery Bypass Grafting, Significant stenosis with conservative therapy, Death) | 6 weeks after presentation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The number of patients undergoing Coronary ArterioGraphy (CAG) |  | Three months after presentation | 
| The number of patients suffering Acute Coronary Syndrome (ACS) | According to adjudication committee | 3 months after presentation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Risk scores, ACS, HEART-score