Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome
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Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome. / Meier, Mario; Boeddinghaus, Jasper; Nestelberger, Thomas; Koechlin, Luca; Lopez-Ayala, Pedro; Wussler, Desiree; Walter, Joan Elias; Zimmermann, Tobias; Badertscher, Patrick; Wildi, Karin; Giménez, Maria Rubini; Puelacher, Christian; Glarner, Noemi; Magni, Jan; Miró, Òscar; Martin-Sanchez, Francisco Javier; Kawecki, Damian; Keller, Dagmar I; Gualandro, Danielle M; Twerenbold, Raphael; Nickel, Christian H; Bingisser, Roland; Mueller, Christian; APACE Investigators.
in: EUR HEART J-ACUTE CA, Jahrgang 12, Nr. 10, 25.10.2023, S. 693-702.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome
AU - Meier, Mario
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Koechlin, Luca
AU - Lopez-Ayala, Pedro
AU - Wussler, Desiree
AU - Walter, Joan Elias
AU - Zimmermann, Tobias
AU - Badertscher, Patrick
AU - Wildi, Karin
AU - Giménez, Maria Rubini
AU - Puelacher, Christian
AU - Glarner, Noemi
AU - Magni, Jan
AU - Miró, Òscar
AU - Martin-Sanchez, Francisco Javier
AU - Kawecki, Damian
AU - Keller, Dagmar I
AU - Gualandro, Danielle M
AU - Twerenbold, Raphael
AU - Nickel, Christian H
AU - Bingisser, Roland
AU - Mueller, Christian
AU - APACE Investigators
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/10/25
Y1 - 2023/10/25
N2 - AIMS: The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician.METHODS AND RESULTS: Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study. We compared the prognostic performance of the HEART score, GRACE score, T-MACS, TIMI score, and EDACS, as well as the unstructured ICJ of the treating ED physician (visual analogue scale to estimate the probability of acute coronary syndrome, ranging from 0 to 100). Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART score, GRACE score, T-MACS, and ICJ [area under the receiver operating characteristic curve (AUC) 0.85-0.87] but significantly lower and only moderate for the TIMI score (AUC 0.79, P < 0.001) and EDACS (AUC 0.74, P < 0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93-96, 87 (P < 0.001), and 72% (P < 0.001), respectively.CONCLUSION: The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use.TRIAL REGISTRATION: ClinicalTrials.gov number NCT00470587.
AB - AIMS: The utility of clinical risk scores regarding the prediction of major adverse cardiac events (MACE) is uncertain. We aimed to directly compare the prognostic performance of five established clinical risk scores as well as an unstructured integrated clinical judgement (ICJ) of the treating emergency department (ED) physician.METHODS AND RESULTS: Thirty-day MACE including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (including the index event), and unstable angina requiring urgent coronary revascularization were centrally adjudicated by two independent cardiologists in patients presenting to the ED with acute chest discomfort in an international multicentre study. We compared the prognostic performance of the HEART score, GRACE score, T-MACS, TIMI score, and EDACS, as well as the unstructured ICJ of the treating ED physician (visual analogue scale to estimate the probability of acute coronary syndrome, ranging from 0 to 100). Among 4551 eligible patients, 1110/4551 patients (24.4%) had at least one MACE within 30 days. Prognostic accuracy was high and comparable for the HEART score, GRACE score, T-MACS, and ICJ [area under the receiver operating characteristic curve (AUC) 0.85-0.87] but significantly lower and only moderate for the TIMI score (AUC 0.79, P < 0.001) and EDACS (AUC 0.74, P < 0.001), resulting in sensitivities for the rule-out of 30-day MACE of 93-96, 87 (P < 0.001), and 72% (P < 0.001), respectively.CONCLUSION: The HEART score, GRACE score, T-MACS, and unstructured ICJ of the treating physician, not the TIMI score or EDACS, performed well for the prediction of 30-day MACE and may be considered for routine clinical use.TRIAL REGISTRATION: ClinicalTrials.gov number NCT00470587.
KW - Humans
KW - Acute Coronary Syndrome/diagnosis
KW - Risk Assessment/methods
KW - Chest Pain/etiology
KW - Prospective Studies
KW - Risk Factors
KW - Clinical Reasoning
KW - Emergency Service, Hospital
U2 - 10.1093/ehjacc/zuad081
DO - 10.1093/ehjacc/zuad081
M3 - SCORING: Journal article
C2 - 37435949
VL - 12
SP - 693
EP - 702
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 10
ER -