Comparison of three risk stratification rules for predicting patients with acute coronary syndrome presenting to an australian emergency department

Louise Cullen, Jaimi Greenslade, Christopher J. Hammett, Anthony F T Brown, Derek P. Chew, Jennifer Bilesky, Martin Than, Arvin Lamanna, Kimberley Ryan, Kevin Chu, William A. Parsonage

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33 Citations (Scopus)


Objectives: To compare the predictive ability of three risk stratification tools used to assess patients presenting to the ED with potential acute coronary syndrome. Design: Pre-planned analysis of an observational study. Setting: A single tertiary referral hospital. Participants: 1495 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. Interventions: Subjects 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 measurement: 30-Day cardiac event rates including cardiac death, acute myocardial infarction and unstable angina. Results: There 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. Conclusions: All 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.

Original languageEnglish
Pages (from-to)844-851
Number of pages8
JournalHeart Lung and Circulation
Issue number10
Publication statusPublished - 1 Oct 2013


  • Acute coronary syndrome
  • Chest pain
  • Emergency
  • Risk stratification

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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