ABC | Volume 114, Nº5, May 2020

Original Article Torralba et al. HEART, TIMI, and GRACE scores for MACE prediction Arq Bras Cardiol. 2020; 114(5):795-802 Figure 1 – Patients of the study. 968 chest pain patients 557 patients included 519 patients analyzed No MACE at 30 day = 295 patients MACE at 30 day = 224 patients 38 lost of follow up Death = 3 patients Myocardial infarction = 194 patients Surgical revascularization = 46 patients Percutaneous revascularization = 108 patients 411 excluded because of very low probability or non cardiogenic pain Costochondritis = 152 Pericarditis = 25 Pulmonary embolism = 71 Pneumonia = 57 Esophageal reflux/peptic cause = 58 Psychogenic = 18 Unknown = 30 Limitations The TIMI and GRACE score were developed as tools to quantify risk in patients with an established diagnosis of acute coronary syndrome, whereas the HEART score was designed to assess patients with chest pain. However, despite the difference in their initial objective, in real-world clinical practice they have been used interchangeably. Furthermore, previous studies have compared the scores for risk assessment of chest pain in emergency settings. This research protocol was carried out in a single specialized center, which may not accurately reflect the behavior of other populations in centers with different levels of complexity or in different regions or countries. Therefore, new studies with larger, multicentric populations will be required in the future to enhance the applicability of these findings. Although the sample size was smaller than initially calculated, the fact that a greater number of MACE (n = 224) was obtained in the analyzed group of 519 patients made it possible to calculate an adequate power greater than 80%. Additionally, different factors may affect score applicability, as patients may not always provide accurate clinical history, and therefore risk factors may not be adequately reported. Electrocardiographic changes and troponin elevations may be non-significant in the early stages of myocardial infarction, or they may be falsely elevated by other disorders such as chronic kidney disease, heart failure, arrhythmias, tachycardia, and sepsis, among others. Finally, the follow-up information is based on the data provided by patients and their family members, which could limit the reliability of the data. Although the information is based on a structured format with 4 clear questions, it may be subject to misinterpretation. Conclusions We found that the HEART score was more effective in predicting MACE at 30 days of follow up compared to the TIMI and GRACE scores in the era of hsTnI in an exclusively Latin- American population with chest pain of suspected cardiac origin at a high complexity cardiovascular center. 798