It has been shown to both predict in-hospital and long-term mortality.Įstimates mortality for patients with unstable angina and non-ST elevation MI.Ĭan be used to help risk stratify patients with presumed ischemic chest pain. It was also validated against a registry of over 300,000 NSTEMI patients. Provides mortality estimate in patients with ACS using only blood pressure, heart rate, and age.Ī simple calculator to predict 30-day mortality, which has been well validated against a registry of 150,000 STEMI patients, and shown to have a very good discriminatory capacity. IMPORTANT: ADD-RS + D-dimer (the ADvISED study algorithm) has not been externally validated in ruling out acute aortic dissection and should thus be used with caution. WHEN TO USE: Patients with chest pain that may be cardiac in nature.ĪDD-RS (Aortic Dissection Detection Risk Score) T-MACS (MD-Calc) ( Troponin-only Manchester Acute Coronary Syndromes Decision Aid) INSTRUCTIONS: Use in patients ≥18 years old presenting with suspected cardiac chest pain (symptoms within the last 24 hours). Stratifies ACS risk with history and EKG only (not yet externally validated). HE-MACS (MD-Calc) ( History and Electrocardiogram-only Manchester Acute Coronary Syndromes) Sgarbossa's is a well accepted approach at determining which LBBB are having an MI. About 1 in 200 patients with MI have LBBB. It's often difficult to identify an MI for patients with existing left bundle branch blocks (LBBB). The cut off value for GRACE in detecting severe CAD was 138 while that of TIMI was 3.Ĭonclusion: The GRACE score identifies severe CAD with higher discriminatory ability and predictive accuracy compared to TIMI, therefore it is the favored risk stratification system to be used in Filipino patients with NSTE-ACS.Criteria to diagnose acute MI in patients with prior LBBB. Severe CAD was also more accurately predicted by the GRACE score (specificity of 74.2%, sensitivity of 72% ) versus the TIMI (specificity of 61.6%, sensitivity of 68.2%). The GRACE score had higher discriminatory ability compared to TIMI in identifying severe CAD (AUROC curve score of 0.77 versus 0.65, p=0.006). Fifty percent (50%) had high risk GRACE score, 59% had high risk TIMI score while 53.5% had severe CAD. The mean age was 70☑2 years and majority (69%) were males. Results: There were 200 subjects included in this study. The discriminative ability of the risk scores were determined using the area under the ROC curve statistics while the predictive accuracies were computed via sensitivity and specificity analyses. The GRACE and TIMI risk scores were computed and the severity of CAD was established after review of individual coronary angiogram. Methods: This is a cross-sectional, analytic study involving NSTE-ACS patients admitted to the Philippine Heart Center from 2006 to 2016. This study compared the discriminative ability and accuracy of these scoring systems in predicting the severity of CAD lesions in patients with NSTE-ACS. These scoring systems should also be able to predict the patients' severity of coronary artery disease (CAD) anatomy because this may modify the management strategy. Background: Risk stratification in non-ST elevation ACS (NSTE-ACS) using the GRACE and the TIMI risk scores is essential as those identified to be high risk patients benefit most from early invasive treatment.
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