• Stephen P J Macdonald, Yusuf Nagree, Daniel M Fatovich, Helen L Flavell, and Francis Loutsky.
• Emergency Department, Armadale Health Service, Western Australia, Australia. stephen.macdonald@health.wa.gov.au
• Emerg Med Australas. 2011 Dec 1;23(6):717-25.

ObjectiveTo compare two methods of risk stratification for suspected acute coronary syndrome (ACS) in the ED.MethodsA prospective observational multicentre study was undertaken of patients undergoing evaluation in the ED for possible ACS. We compared the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline and the Thrombolysis in Myocardial Infarction (TIMI) risk score for differentiating high- and low-risk patients. Composite outcome was all cause death, myocardial infarction or coronary revascularisation within 30 days.ResultsOf 1758 enrolments, 223 (13%) reached the study outcome. Area under the receiver operator characteristic (ROC) curve was 0.79 (95% CI 0.76-0.81) for the NHF/CSANZ group and 0.71 (0.68-0.75) for TIMI score based on initial troponin result (P<0.001), and 0.82 (95% CI 0.80-0.84) and 0.76 (0.73-0.79) respectively when the 8-12 h troponin result is included (P=0.001). Thirty day event rates were 33% for NHF/CSANZ high-risk vs 1.5% for combined low/intermediate risk (P<0.001). For TIMI score, 30 day event rates were 23% for a score ≥2 and 4.8% for TIMI<2 (P<0.001). The NHF/CSANZ guideline identified more patients as low risk compared with the TIMI risk score (61% vs 48%, P<0.001).ConclusionsThe NHF/CSANZ guideline is superior to the TIMI risk score for risk stratification of suspected ACS in the ED.© 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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