Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospital study

Priyanka T. Bhattacharya, Reshma R. Golamari, Sandhya Vunnam, Smitha Moparthi, Neethi Venkatappa, Denis J. Dollard, Jose Missri, Wei Yang, Stephen E. Kimmel, Giovanni Tarantino

Research output: Contribution to journalArticle

Abstract

Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P=.004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P=.011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.

Original languageEnglish (US)
Article numbere16370
JournalMedicine (United States)
Volume98
Issue number32
DOIs
StatePublished - Aug 1 2019

Fingerprint

Troponin
Age Factors
Urban Hospitals
Community Hospital
Chest Pain
African Americans
Electrocardiography
History
Myocardial Infarction
Logistic Models
Hospital Emergency Service
Decision Support Techniques
Confidence Intervals
Patient Discharge
Population
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Bhattacharya, Priyanka T. ; Golamari, Reshma R. ; Vunnam, Sandhya ; Moparthi, Smitha ; Venkatappa, Neethi ; Dollard, Denis J. ; Missri, Jose ; Yang, Wei ; Kimmel, Stephen E. ; Tarantino, Giovanni. / Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients : An African American urban community based hospital study. In: Medicine (United States). 2019 ; Vol. 98, No. 32.
@article{09f2eadbe6a34c5aaaf93c252426319b,
title = "Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospital study",
abstract = "Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95{\%} confidence interval [CI] 1.43-6.76, P=.004) with increase in risk category from low to moderate vs. 2.07 (95{\%} CI 1.18-3.63, P=.011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2{\%} to 4{\%} miss rate threshold probability should be to discharge these patients from the ED.",
author = "Bhattacharya, {Priyanka T.} and Golamari, {Reshma R.} and Sandhya Vunnam and Smitha Moparthi and Neethi Venkatappa and Dollard, {Denis J.} and Jose Missri and Wei Yang and Kimmel, {Stephen E.} and Giovanni Tarantino",
year = "2019",
month = "8",
day = "1",
doi = "10.1097/MD.0000000000016370",
language = "English (US)",
volume = "98",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "32",

}

Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients : An African American urban community based hospital study. / Bhattacharya, Priyanka T.; Golamari, Reshma R.; Vunnam, Sandhya; Moparthi, Smitha; Venkatappa, Neethi; Dollard, Denis J.; Missri, Jose; Yang, Wei; Kimmel, Stephen E.; Tarantino, Giovanni.

In: Medicine (United States), Vol. 98, No. 32, e16370, 01.08.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients

T2 - An African American urban community based hospital study

AU - Bhattacharya, Priyanka T.

AU - Golamari, Reshma R.

AU - Vunnam, Sandhya

AU - Moparthi, Smitha

AU - Venkatappa, Neethi

AU - Dollard, Denis J.

AU - Missri, Jose

AU - Yang, Wei

AU - Kimmel, Stephen E.

AU - Tarantino, Giovanni

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P=.004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P=.011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.

AB - Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817 patients included, 500 patients had low HEART score vs. 317 patients who had moderate HEART score. Six hundred sixty-three patients had low TIMI score vs. 154 patients had high TIMI score. The univariate logistic regression model shows odds ratio of predicting 6-week MACE using HEART score was 3.11 (95% confidence interval [CI] 1.43-6.76, P=.004) with increase in risk category from low to moderate vs. 2.07 (95% CI 1.18-3.63, P=.011) using TIMI score with increase in risk category from low to high and c-statistic of 0.86 vs. 0.79, respectively. DCA showed net benefit of using HEART score is equally predictive of 6-week MACE when compared to TIMI.In non-high CV risk AA patients, HEART score is better predictive tool for 6-week MACE when compared to TIMI score. Furthermore, patients presenting to ED with chest pain, the optimal strategy for a 2% to 4% miss rate threshold probability should be to discharge these patients from the ED.

UR - http://www.scopus.com/inward/record.url?scp=85070535858&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070535858&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000016370

DO - 10.1097/MD.0000000000016370

M3 - Article

C2 - 31393346

AN - SCOPUS:85070535858

VL - 98

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 32

M1 - e16370

ER -