20Īlthough both risk scores have been validated for use in a low-risk ED population, they are mostly not yet actively used that is, no policy decision is made based on the individual risk score of a patient. A recent study suggests that a TIMI score of 0 and HEART score of ≤3 with high-sensitivity troponin I could achieve a negative predictive value ≥99.5% while identifying more than 30% of patients as suitable for immediate discharge. 9 11 14 15 17–19 In a previous study by Mahler et al, 14 the HEART score identified 20% (95% CI 18% to 23%) as low risk (HEART score 3 or lower) with a corresponding sensitivity of 99% (95% CI 97% to 100%) for ACS. Such a low-risk group can then be considered for early discharge from the ED. It has been specifically developed for patients with chest pain and previous prospective studies indicated the HEART score as valid for patient stratification, especially in identifying a low-risk group of patients without compromising safety. These components can be rated 0, 1 or 2 points each and results in a total HEART score between 0 and 10, as shown in table 2. 9 11–16 The HEART score is an acronym for History, ECG, Age, Risk factors and Troponin. Second, the HEART score was developed in 2007 and has been validated to stratify the risk of short-term adverse cardiac events in patients with chest pain at the ED. 10ĬAD, Coronary artery disease NSTEMI, non-ST-segment elevation myocardial infarction. It is one of the two risk scores that is implemented in current international guidelines and well known by most clinicians. 8 9 The TIMI score is composed of seven elements as shown in table 1. 6 7 The current study investigates two of these risk scores, namely the thrombosis in myocardial infarction (TIMI) score and the HEART score.įirst, the TIMI risk score was developed in 2000 to stratify risk in patients with chest pain admitted to the cardiac care unit (CCU) and can be used to predict 30-day outcomes of mortality, myocardial infarction (MI) and severe recurrent ischaemia requiring urgent revascularisation. Currently, international cardiac guidelines recommend the use of a risk score for risk stratification. Several risk stratification tools and prediction models have been developed over time. 4 The question remains whether this conservative approach leads to better clinical outcomes for patients and there is discussion on optimal management in patients who are deemed safe to discharge from the ED. However, often results of these performed tests are normal. Therefore, the majority of low-risk patients are currently admitted to the hospital to undergo further testing, regardless of low pretest probability. 3 Differentiating between low-risk and high-risk patients for ACS remains a diagnostic challenge, since a normal ECG and initially negative biomarkers do not exclude ACS. 1 2 Of all these patients, the majority has chest pain due to non-cardiac causes and only 15–20% of patients have an ACS. Each year, an estimated 6% of presentations at emergency departments (EDs) are attributed to symptoms suspicious of acute coronary syndrome (ACS).

Timi score and american