系统评价和荟萃分析：比较 TIMI、HEART 和 GRACE 评分预测急诊科因急性胸痛入院的患者发生主要心血管事件的能力。

Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis.

机构信息

Department of Emergency, Fujian Provincial Hospital, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou, China.

Fujian Provincial Institute of Emergency Medicine, Fuzhou, China.

出版信息

BMJ Open. 2021 Aug 18;11(8):e048356. doi: 10.1136/bmjopen-2020-048356.

BACKGROUND

The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED).

METHODS

We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC).

RESULTS

The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs.

CONCLUSIONS

TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.

背景

本研究旨在比较溶栓治疗心肌梗死（TIMI）评分系统、历史、心电图、年龄、危险因素和肌钙蛋白（HEART）评分系统与全球急性冠状动脉事件注册（GRACE）评分系统对因急性胸痛（ACP）收入急诊科（ED）的患者发生主要不良心血管事件（MACE）的预测价值。

方法

我们系统地检索了 PubMed、Embase 和 Cochrane 图书馆从建库至 2020 年 6 月的数据，比较了以下参数：敏感性、特异性、阳性和阴性似然比（PLR 和 NLR）、诊断比值比（DOR）和受试者工作特征曲线下的面积（AUC）。

结果

TIMI、HEART 和 GRACE 的汇总敏感性和特异性分别为 0.95 和 0.36、0.96 和 0.50、0.78 和 0.56。TIMI、HEART 和 GRACE 的汇总 PLR 和 NLR 分别为 1.49 和 0.13、1.94 和 0.08、1.77 和 0.40。TIMI、HEART 和 GRACE 的汇总 DOR 分别为 9.18、17.92 和 4.00。TIMI、HEART 和 GRACE 的 AUC 分别为 0.80、0.80 和 0.70。最后，间接比较的结果表明 TIMI 和 HEART 值在预测 MACE 方面优于 GRACE 值，而 TIMI 和 HEART 值在预测 MACE 方面无显著差异。