A Comparison of the TIMI, GRACE, HEART and HEARTSIL Scores
A Comparison of the TIMI, GRACE, HEART and HEARTSIL Scores
Chest pain is one of the most common reasons for emergency admission. Chest pain can be
 caused by many cardiac and noncardiac causes. Acute Coronary Syndrome (ACS) is one of the
 most im-portant of these etiologies. ACS has a high mortality rate, but with early diagnosis
 and related inter-ventions, a high rate of prognosis can be improved. Therefore, early
 recognition of AKS is impor-tant. However, the challenge in emergency services is not only to
 identify patients with high risk for ACS. Early detection of low-risk patients is also
 important for emergency room management. These patients should be discharged quickly with
 minimal examination and treatment. The follow-up of these patients with the acceptance of ACS
 brings along unnecessary examinations and treatments. This leads to an increase in healthcare
 costs and an increase in crowd in emergency services and hospitals.

 Evaluation of chest pain in the emergency room and early detection of life-threatening
 conditions such as ACS present many difficulties for clinicians. For this reason, clinicians
 use some scoring systems that determine the risk stratification of patients and the
 probability of having acute coronary syndrome. Heart score is one of the scores developed for
 this purpose. However vital signs are not included in calculating the heart score. Therefore,
 the investigators considered to include the shock index calcula-ted by systolic blood
 pressure and pulse in this scoring system. In addition, the investigators have included a
 very valuable biochemical parameter such as lactate that predicts mortality in many diseases
 in this scoring system. The investigators named this scoring system HEARTSIL. The
 investigators aim to compare the diagnostic performance of this score with the diagnostic
 performance of other scoring systems.
The study was planned to be conducted in Konya City Hospital Emergency Service. Adult
 patients over 18 years of age who present to the emergency department with chest pain will be
 included in the study. Patients who do not consent to participate in the study due to chest
 pain such as ST elevation myocardial infarction, pneumonia, pneumothorax, pulmonary embolism
 and esophageal rupture will be excluded from the study. Vital signs of the patients,
 background information, the nature of the pain, the drugs used will be recorded. Blood tests
 and electrocardiogram will be recorded. Heart Score, TIMI, GRACE score will be calculated.
 Shock index and lactate value will also be included in the heart score. Shock index 0.5-0.7 =
 0 points, 0.71-1 = 1 point and above 1 will be cal-culated as 2 points. Lactate levels 0-2
 mEq/L =0 points, between 2,1-3,99 mEq/L= 1 point, above 4 mEq/L levels will be calculated 2
 points. These points will be added to the Heart Score and will be named HEARTSIL. Patients
 will be followed in terms of major cardiac events (MACE) for 3 days and 1 month. Prog-nostic
 performance of HEARTSIL Score, Heart Score, GRACE, TIMI scores that the investigators
 developed will be compared.

 The data will be uploaded to the database for statistics. First of all, whether the data is
 normally distributed or not will be determined. Student-t for normally distributed data,
 Mann-witney-u test for data that are not normally distributed, and chi-square will be used
 for comparing categorical data. The ROC curve will be drawn and compared in determining the
 prognostic performance of scoring systems for MACE development. In addition, PPD, NPD, +LR
 and -LR sensitivity and spe-cificities will be calculated. Values with a p value below 0.05
 will be considered statistically signifi-cant.
Inclusion Criteria:

 -  Patient presenting to the emergency department with chest pain

 Exclusion Criteria:

 -  ST elevation myocardial infarction,

 -  Pneumonia, pneumothorax, pulmonary embolism and esophageal rupture

 -  Patients under 18 years of age

 -  Pregnant patients

 -  Patients who do not want to be included in the study