COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.

Alok Gangurde,Dhiraj Jadhav,Ishan Lamba,Sumalya Tripathi,Sweta K,V S Shinde,Zahid Shaikh

doi:10.32553/ijmbs.v3i11.746

Abstract

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients. We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS. Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility. Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS

Highlights

One of the most common presentations at emergency department (ED) is the patients complaining of acute onset chest pain
We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk acute coronary syndrome (ACS)
The most commonly used of these scores are HEART (History, ECG, Age, Risk factors and Troponin), TIMI(Thrombolysis In Myocardial Infarction), GRACE(Global Registry of Acute Coronary Events), NACP(North America Chest Pain Rule), ADAPT(Accelerated Diagnostic protocol to Access Patients with chest pain using contemporary Troponin as the only biomarker), EDACS(Emergency Department Assessment of Chest pain Score), etc

Summary

Introduction

One of the most common presentations at ED is the patients complaining of acute onset chest pain. Of these patients 7% will have ACS with 6%-10% having positive cardiac biomarkers at initial contact. To help identify patients requiring further management risk stratification scores and accelerated diagnostic protocols (ADP) have been generated and successfully implemented in various studies across the globe. The most commonly used of these scores are HEART (History, ECG, Age, Risk factors and Troponin), TIMI(Thrombolysis In Myocardial Infarction), GRACE(Global Registry of Acute Coronary Events), NACP(North America Chest Pain Rule), ADAPT(Accelerated Diagnostic protocol to Access Patients with chest pain using contemporary Troponin as the only biomarker), EDACS(Emergency Department Assessment of Chest pain Score), etc. As the patients with low risk ACS already have a negative ECG and cardiac biomarkers are not raised the total score value decreases

EDACS Age

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