Evaluation of HEART score, GRACE 2.0 score, and TIMI score for Risk Stratification in Acute Coronary Syndrome: A Single-Centre Pilot Study in a Sri Lankan Population

Objectives HEART score is widely used for risk stratification in patients with chest pain to rule out acute coronary syndrome (ACS). Although limited, it has been validated in several countries throughout the world. TIMI and GRACE 2.0 scores are recommended for prognostication in patients with ACS. This study aimed to explore the effectiveness of HEART score in a Sri Lankan population for risk stratification in patients presenting with chest pain and to compare its performance with GRACE 2.0 and TIMI scores. Methods Data was collected from 74 patients presenting to the emergency department at a tertiary care centre in Sri Lanka. HEART, GRACE 2.0 and TIMI scores were calculated for each patient separately. The predictive accuracy of the HEART score with a diagnosis of ACS and the occurrence of major adverse cardiac events (MACE) at 6 weeks was assessed and compared with TIMI and GRACE 2.0 scores. Results Area under receiver operating curve (AUC-ROC) for HEART, GRACE 2.0 and TIMI, for a diagnosis of ACS, were 0.889 (95% CI: 0.8171 — 0.9609), 0.805 (95% CI: 0.6758 — 0.9349), 0.812 (95% CI: 0.6961 — 0.9278) respectively. Delongs test did not indicate a significant pairwise difference in scores. AUC-ROC for occurrence of MACE were 0.905 (95% CI: 0.8437 — 0.9669), 0.721 (95% CI: 0.5934 — 0.8493) and 0.767 (95% CI: 0.6467 — 0.888), for HEART, GRACE 2.0 and TIMI scores respectively, and these differences were statistically significant. Conclusions HEART score is an effective score which can be used in Sri Lankans, in predicting the probability of ACS, and MACE within 6 weeks, in patients presenting with chest pain. It is comparable to GRACE 2.0 and TIMI scores in diagnostic accuracy while it is superior to GRACE and TIMI scores in predictive accuracy for short term risk of MACE. Key words –HEART score, GRACE score, TIMI score, Acute coronary syndrome, MACE