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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, Vol. 12, No. 10, 25.10.2023, p. 693-702.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Meier, M, Boeddinghaus, J, Nestelberger, T, Koechlin, L, Lopez-Ayala, P, Wussler, D, Walter, JE, Zimmermann, T, Badertscher, P, Wildi, K, Giménez, MR, Puelacher, C, Glarner, N, Magni, J, Miró, Ò, Martin-Sanchez, FJ, Kawecki, D, Keller, DI, Gualandro, DM, Twerenbold, R, Nickel, CH, Bingisser, R, Mueller, C & APACE Investigators 2023, 'Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome', EUR HEART J-ACUTE CA, vol. 12, no. 10, pp. 693-702. https://doi.org/10.1093/ehjacc/zuad081

APA

Meier, M., Boeddinghaus, J., Nestelberger, T., Koechlin, L., Lopez-Ayala, P., Wussler, D., Walter, J. E., Zimmermann, T., Badertscher, P., Wildi, K., Giménez, M. R., Puelacher, C., Glarner, N., Magni, J., Miró, Ò., Martin-Sanchez, F. J., Kawecki, D., Keller, D. I., Gualandro, D. M., ... APACE Investigators (2023). Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome. EUR HEART J-ACUTE CA, 12(10), 693-702. https://doi.org/10.1093/ehjacc/zuad081

Vancouver

Meier M, Boeddinghaus J, Nestelberger T, Koechlin L, Lopez-Ayala P, Wussler D et al. Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome. EUR HEART J-ACUTE CA. 2023 Oct 25;12(10):693-702. https://doi.org/10.1093/ehjacc/zuad081

Bibtex

@article{7f7df2cae36e4aceb272f7cf9cfbdcb6,
title = "Comparing the utility of clinical risk scores and integrated clinical judgement in patients with suspected acute coronary syndrome",
abstract = "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.",
keywords = "Humans, Acute Coronary Syndrome/diagnosis, Risk Assessment/methods, Chest Pain/etiology, Prospective Studies, Risk Factors, Clinical Reasoning, Emergency Service, Hospital",
author = "Mario Meier and Jasper Boeddinghaus and Thomas Nestelberger and Luca Koechlin and Pedro Lopez-Ayala and Desiree Wussler and Walter, {Joan Elias} and Tobias Zimmermann and Patrick Badertscher and Karin Wildi and Gim{\'e}nez, {Maria Rubini} and Christian Puelacher and Noemi Glarner and Jan Magni and {\`O}scar Mir{\'o} and Martin-Sanchez, {Francisco Javier} and Damian Kawecki and Keller, {Dagmar I} and Gualandro, {Danielle M} and Raphael Twerenbold and Nickel, {Christian H} and Roland Bingisser and Christian Mueller and {APACE Investigators}",
note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.",
year = "2023",
month = oct,
day = "25",
doi = "10.1093/ehjacc/zuad081",
language = "English",
volume = "12",
pages = "693--702",
journal = "EUR HEART J-ACUTE CA",
issn = "2048-8726",
publisher = "SAGE Publications",
number = "10",

}

RIS

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 -