The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain

Abstract

The history, electrocardiogram, age, risk factors, troponin (HEART) and global registry of acute coronary events (GRACE) scoring systems are commonly used to risk stratify patients with chest pain. This study investigated the application of these scores in predicting the short-term risk of a major adverse cardiac event (MACE) in patients with chest. A total of 509 patients were analyzed. All patients were followed up for 30 days after visiting our emergency department. At 30 days post-admission, the primary outcome (MACE) was recorded in 92 patients (18.1%), 88 (95.6%) of whom had experienced an acute myocardial infarction. Thirty-seven (40.2%) of the patients with a MACE underwent percutaneous coronary intervention and six patients (6.5%) died. The HEART and GRACE scores were both significantly higher in patients who developed a MACE than in those without (P < 0.05). The HEART and GRACE scores had c-statistic values of 0.811 (95% CI 0.774–0.844) and 0.648 (95% CI 0.603–0.688), respectively. The Hosmer–Lemeshow statistic revealed that the HEART and GRACE scores had values of 8.68 (P = 0.39) and 10.45 (P = 0.11), respectively. The percentages of patients with HEART scores of 0–3, 4–6, and 7–10 were 3.0%, 26.2%, and 46.3%, respectively, in those with a MACE within 30 days. The findings show that while both scoring systems are useful, the HEART score is superior to the GRACE score for predicting the occurrence of MACE within 30 days in patients with chest pain.

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Funding

The study was financially supported by grants from the National Natural Scientific Foundation of China (grant numbers 81670220, 31270992, and 30800215), the project of Guangdong Province Science and Technology Plan (grant numbers 2015A020212013 and 2013B021800275), Guangdong Natural Science Foundation (grant number 2014A030313086), the Fundamental Research Funds for Central Universities in Sun Yat-Sen University (grant numbers 17ykzd18 and 13ykpy24), the project of science and technology program of Guangzhou City (201803010008 and 201804010007), and the international scientific and technological cooperation project of Guangzhou Economic and Technological Development Zone (2017GH13).

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Correspondence to Zhen Yang or Hong Zhan.

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The study was approved by the Ethical Committees of our hospital and in accordance with Declaration of Helsinki.

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Huang, Z., Wang, K., Yang, D. et al. The predictive value of the HEART and GRACE scores for major adverse cardiac events in patients with acute chest pain. Intern Emerg Med 16, 193–200 (2021). https://doi.org/10.1007/s11739-020-02378-0

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Keywords

  • HEART risk score
  • GRACE risk score
  • Acute chest pain
  • Emergency department
  • 30-Day MACE