Kabiri Ali, Gharin Pantea, Forouzannia Seyed Ali, Ahmadzadeh Koohyar, Miri Reza, Yousefifard Mahmoud
Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2023 Jul 19;11(1):e50. doi: 10.22037/aaem.v11i1.2001. eCollection 2023.
Several scoring systems have been proposed to predict the outcomes of patients with ischemic heart disease. Global Registry of Acute Coronary Events (GRACE) and History, ECG, Age, Risk Factors, and Troponin (HEART) scores are two of the more widely used risk prediction tools in patients with acute coronary syndrome (ACS). The present systematic review and meta-analysis aimed to compare the value of GRACE and HEART scores in the outcome prediction of ACS patient.
The online databases of Medline, Embase, Web of Science, and Scopus were search until September 2022 for articles directly comparing GRACE and HEART scores value in prediction of outcome in patients with ACS. GRACE score cut-offs were categorized into two groups of less than and equal to 100 and more than 100, and HEART score cut-offs were categorized into three groups of less than 4, equal to 4, and more than 4. Investigated outcomes were major adverse cardiovascular events (MACE), acute myocardial infraction (AMI) and all-cause mortality.
25 articles were included. The sensitivity and specificity of the GRACE score for prediction of MACE were 0.96 and 0.26 for cut-offs of ≤ 100, and 0.58 and 0.69 for cut-offs of >100, respectively. The sensitivity and specificity of the HEART score for prediction of MACE were 0.99 and 0.16 for cut-offs less than 4, 0.93 and 0.47 for equal to 4, and 0.77 and 0.78 for cut-offs greater than 4. GRACE score was shown to be predictive of AMI with sensitivity and specificity of 0.95 and 0.29, respectively. The analysis for the value of HEART score in the prediction of AMI a sensitivity and specificity of 0.94 and 0.48, respectively. The risk scores were not found to be suitable predictors of all-cause mortality.
The results demonstrated the low specificity of GRACE and HEART scores in predicting the MACE, AMI and all-cause mortality, irrespective of the utilized cut-off. Considering the acceptable sensitivity of two scores in predicting the MACE and AMI, these scores were more suitable to be used as a rule-out tool for identification of ACS patients with low risk of developing adverse outcomes.
已经提出了几种评分系统来预测缺血性心脏病患者的预后。全球急性冠状动脉事件注册研究（GRACE）评分和病史、心电图、年龄、危险因素及肌钙蛋白（HEART）评分是急性冠状动脉综合征（ACS）患者中使用较广泛的两种风险预测工具。本系统评价和荟萃分析旨在比较GRACE评分和HEART评分在ACS患者预后预测中的价值。
检索Medline、Embase、Web of Science和Scopus的在线数据库，直至2022年9月，查找直接比较GRACE评分和HEART评分在ACS患者预后预测中的价值的文章。GRACE评分临界值分为小于或等于100和大于100两组，HEART评分临界值分为小于4、等于4和大于4三组。研究的结局为主要不良心血管事件（MACE）、急性心肌梗死（AMI）和全因死亡率。
纳入25篇文章。GRACE评分预测MACE的敏感性和特异性，临界值≤100时分别为0.96和0.26，临界值>100时分别为0.58和0.69。HEART评分预测MACE的敏感性和特异性，临界值小于4时分别为0.99和0.16，等于4时分别为0.93和0.47，大于4时分别为0.77和0.78。GRACE评分预测AMI的敏感性和特异性分别为0.95和0.29。HEART评分预测AMI的敏感性和特异性分别为0.94和0.48。未发现风险评分是全因死亡率的合适预测指标。
结果表明，无论采用何种临界值，GRACE评分和HEART评分在预测MACE、AMI和全因死亡率方面的特异性均较低。考虑到这两种评分在预测MACE和AMI方面具有可接受的敏感性，这些评分更适合用作排除工具，以识别发生不良结局风险较低的ACS患者。
