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Ability of risk scores to predict a low complication risk in patients admitted for suspected acute coronary syndrome.

Söderholm, Martin LU ; Deligani, Mark Mazdak; Choudhary, Mariam LU ; Björk, Jonas LU and Ekelund, Ulf LU (2012) In Emergency medicine journal : EMJ 29. p.644-649
Abstract
Background When acute coronary syndrome (ACS) cannot be ruled out, emergency department (ED) patients with chest pain are admitted for in-hospital observation because of the risk of complications such as arrhythmia and acute heart failure. A study was undertaken to compare the ability of three risk prediction models to identify patients at a very low risk of complications. Methods 559 consecutive patients with chest pain presenting to the ED and admitted for a suspicion of ACS were prospectively included. Predefined in-hospital complications were recorded and the risk predictions of the Global Registry of Acute Coronary Events (GRACE) risk score, the Freedom-from-Events (FFE) risk score and the Goldman rule were compared using receiver... (More)
Background When acute coronary syndrome (ACS) cannot be ruled out, emergency department (ED) patients with chest pain are admitted for in-hospital observation because of the risk of complications such as arrhythmia and acute heart failure. A study was undertaken to compare the ability of three risk prediction models to identify patients at a very low risk of complications. Methods 559 consecutive patients with chest pain presenting to the ED and admitted for a suspicion of ACS were prospectively included. Predefined in-hospital complications were recorded and the risk predictions of the Global Registry of Acute Coronary Events (GRACE) risk score, the Freedom-from-Events (FFE) risk score and the Goldman rule were compared using receiver operating characteristics (ROC) curves. Results Of the 559 patients, 140 had ACS and 32 had at least one complication. The GRACE score was superior to the FFE score in predicting the risk of complications (area under ROC curve 0.76 (95% CI 0.68 to 0.85) vs 0.69 (95% CI 0.60 to 0.79), p=0.021) whereas the Goldman rule (area under ROC curve 0.60; 95% CI 0.49 to 0.72) was inferior to both the GRACE and FFE scores. With the GRACE score set to a negative predictive value of 100% (95% CI 96% to 100%), 108 patients (19.3%) at almost no risk of complications could have been correctly identified in the ED. Conclusion The GRACE and FFE scores are able to predict low complication risks in patients with chest pain admitted for suspected ACS, but only the GRACE score may be able to identify a significant number of patients at almost no risk of complications. A larger multicentre study is needed to confirm the possibility of using the GRACE score to identify patients suitable for assessment without monitoring. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Emergency medicine journal : EMJ
volume
29
pages
644 - 649
publisher
BMJ Publishing Group
external identifiers
  • wos:000306332800010
  • pmid:21810926
  • scopus:84863949711
ISSN
1472-0213
DOI
10.1136/emermed-2011-200328
language
English
LU publication?
yes
id
0c971e39-9d3d-4196-b103-b429d0371737 (old id 2151592)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21810926?dopt=Abstract
date added to LUP
2011-09-04 16:59:21
date last changed
2017-11-15 12:24:25
@article{0c971e39-9d3d-4196-b103-b429d0371737,
  abstract     = {Background When acute coronary syndrome (ACS) cannot be ruled out, emergency department (ED) patients with chest pain are admitted for in-hospital observation because of the risk of complications such as arrhythmia and acute heart failure. A study was undertaken to compare the ability of three risk prediction models to identify patients at a very low risk of complications. Methods 559 consecutive patients with chest pain presenting to the ED and admitted for a suspicion of ACS were prospectively included. Predefined in-hospital complications were recorded and the risk predictions of the Global Registry of Acute Coronary Events (GRACE) risk score, the Freedom-from-Events (FFE) risk score and the Goldman rule were compared using receiver operating characteristics (ROC) curves. Results Of the 559 patients, 140 had ACS and 32 had at least one complication. The GRACE score was superior to the FFE score in predicting the risk of complications (area under ROC curve 0.76 (95% CI 0.68 to 0.85) vs 0.69 (95% CI 0.60 to 0.79), p=0.021) whereas the Goldman rule (area under ROC curve 0.60; 95% CI 0.49 to 0.72) was inferior to both the GRACE and FFE scores. With the GRACE score set to a negative predictive value of 100% (95% CI 96% to 100%), 108 patients (19.3%) at almost no risk of complications could have been correctly identified in the ED. Conclusion The GRACE and FFE scores are able to predict low complication risks in patients with chest pain admitted for suspected ACS, but only the GRACE score may be able to identify a significant number of patients at almost no risk of complications. A larger multicentre study is needed to confirm the possibility of using the GRACE score to identify patients suitable for assessment without monitoring.},
  author       = {Söderholm, Martin and Deligani, Mark Mazdak and Choudhary, Mariam and Björk, Jonas and Ekelund, Ulf},
  issn         = {1472-0213},
  language     = {eng},
  pages        = {644--649},
  publisher    = {BMJ Publishing Group},
  series       = {Emergency medicine journal : EMJ},
  title        = {Ability of risk scores to predict a low complication risk in patients admitted for suspected acute coronary syndrome.},
  url          = {http://dx.doi.org/10.1136/emermed-2011-200328},
  volume       = {29},
  year         = {2012},
}