Introduction Chest pain is one of the most common presenting complaints in the Emergency Department (ED) accounting for approximately 10% of total ED visits. Clinicians are often challenged in differentiating chest pain associated with significant coronary artery disease (CAD) from non-significant. Both HEART score and GRACE score are often used to risk stratify patients with chest pain in ED. No study has previously compared the two scores in prediction of the presence of significant CAD in a non ACS (Acute Coronary Syndrome) population.
Objective To compare the HEART score with the GRACE score amongst non ACS chest pain patients discharged from ED to chest pain clinic follow up with a confirmed diagnosis of CAD.
Method Retrospective analysis of data collected by the specialist cardiology nurse on non ACS chest pain patients who attended the chest pain clinic from April 2014 to December 2014. Age, gender, detailed history, risk factors, ECG, and high sensitivity troponin were collected. Both HEART score and GRACE scores were calculated on each patient and stratified into low, intermediate and high risk of MACE in both indexes. Presence of CAD was confirmed or excluded by either visual coronary angiography or CT coronary angiography. Primary end point is the evidence of significant coronary artery disease needing medical treatment or angioplasty.
Result A total of 177 out of 403 patients had CT coronary angiography or coronary angiography performed, results available on 111 patients. Mean age was 58.79 ± 10.98 years. 40.54% (n = 45) male and female 59.45% (n = 66). A total of 69.36% (n = 77) patients had coronary angiogram while 30.63% (n = 34) had CT coronary angiogram. Heart score was found to be more sensitive and specific than GRACE; High risk 100% vs 50% (p < 0.05) and low risk 78.6% vs 70.5% (p < 0.05) in detection or exclusion of the presence of significant CAD. See Table 1.
Conclusion In this study the HEART score has shown to be a statistically significant predictor for the diagnosis or exclusion of CAD when compared to the GRACE score. As a result it is the preferred risk stratification tool for the everyday evaluation of patients who present to Tallaght Hospital ED with chest pain.
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