• Louise Cullen, Jaimi Greenslade, Christopher J Hammett, Anthony F T Brown, Derek P Chew, Jennifer Bilesky, Martin Than, Arvin Lamanna, Kimberley Ryan, Kevin Chu, and William A Parsonage.
• Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia. Electronic address: louise_cullen@health.qld.gov.au.
• Heart Lung Circ. 2013 Oct 1;22(10):844-51.

ObjectivesTo compare the predictive ability of three risk stratification tools used to assess patients presenting to the ED with potential acute coronary syndrome.DesignPre-planned analysis of an observational study.SettingA single tertiary referral hospital.Participants1495 patients presented with chest pain. 948 patients were screened and enrolled. Patients with at least 5 min of chest pain suggestive of ACS were eligible.InterventionsSubjects were risk categorised using the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines (HFA/CSANZ), the TIMI score and the GRACE score. Three strata of the TIMI and GRACE score were used to compare to the HFA/CSANZ risk categories.Main Outcome Measurement30-Day cardiac event rates including cardiac death, acute myocardial infarction and unstable angina.ResultsThere were 152 events in 91 patients (9.6%). The discriminatory ability of the scores determined by the AUC was 0.83 (95% CI 0.79-0.87) for the GRACE score, 0.79 (95% CI 0.74-0.83) for TIMI score and 0.75 (95% CI 0.70-0.80) for HFA/CSANZ. The AUCs with three strata of the GRACE and TIMI scores were 0.76 (95% CI 0.72-0.81) and 0.68 (95% CI 0.62-0.73) respectively.ConclusionsAll three scores were similar in performance in quantifying risk in ED patients with possible ACS. The GRACE score identified a sizable low risk cohort with high sensitivity and NPV but complexity of this tool may limit its utility. Improved scores are needed to allow early identification of low- and high-risk patients to support improvements in patient flow and ED overcrowding.Copyright © 2013. Published by Elsevier B.V.

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