Am J Emerg Med. 2022 Oct;60:24-28. doi: 10.1016/j.ajem.2022.07.017. Epub 2022 Jul 16.
ABSTRACT
OBJECTIVES: Guidelines recommend the use of risk scoring in patients with chest pain. In this study, we aimed to compare the thrombolysis in myocardial infarction risk index (TIMI) score with the Troponin Only Manchester Acute Coronary Syndrome Score (T-MACS) score and to investigate the usability of the T-MACS score in the emergency department.
METHODS: In our study; The TIMI and T-MACS scores of 310 patients with suspected NSTEMI who applied to the emergency department with chest pain and met the inclusion and exclusion criteria were prospectively evaluated. The primary outcome was MACE at 30 days including acute coronary syndromes, need for revascularization and deaths. Descriptive data and TIMI and T-MACS scores for predicting MACE and ACS was evaluated by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). ROC (Receiver Operating Characteristic) analysis was also performed to determine TIMI and T-MACS risk class.
RESULTS: In our study, the mean age of the patients was 49.7 ± 19.4 years, the 1-month mortality rate was 1.3%, majör adverse cardiac event (MACE) rate was 6.5%, and acute coronary syndrome (ACS) rate was 5.5%. T-MACS risk class for predicting MACE sensitivity 100%, selectivity 51.72, PPV 12.5% (for very low risk), NPV was calculated as 100%; sensitivity for TIMI risk class low risk 35%, selectivity 88.97%, PPV was calculated as 17.9%, NPV was calculated as 95.2%. T-MACS high risk class for predicting MACE; sensitivity was 60%, selectivity 99.66%, PPV 92.3% and NPV was 97.3%; TIMI high risk class for predicting MACE; sensitivity was 10%, selectivity was 97.93%, PPV was 25% and NPV was 94%.
CONCLUSIONS: The findings obtained in this study suggest that the T-MACS score is more successful than the TIMI score in determining the low risk (very low risk for T-MACS score), high risk, and estimated 1-month MACE risk in cases who presented to the emergency department with chest pain.
PMID:35878571 | DOI:10.1016/j.ajem.2022.07.017