For Ruling Out MI, Which, If Any, Risk Score Is Worth Using?

The TIMI, Goldman, and HEART scores were useful, depending on which troponin assay was used with them.

The number of decision rules for chest pain has become overwhelming. Investigators at a single emergency department in the U.K. prospectively compared the diagnostic utility of five risk scores in combination with high-sensitivity troponin T (hsTnT) or I (hsTnI) testing 6 hours after presentation. The five scores were Thrombolysis in Myocardial Infarction (TIMI); Modified Goldman; Global Registry of Acute Cardiac Events (GRACE); Vancouver Chest Pain Rule; and History, ECT, Age, Risk Factors, Troponin (HEART).

HsTnT testing was performed in 959 patients and hsTnI testing in 867 of them. Eight percent of patients in each group had an acute myocardial infarction within 30 days. Tests were defined as having “optimum clinical utility” if they had…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

For Ruling Out MI, Which, If Any, Risk Score Is Worth Using?

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Reviewing Author