Accuracy of risk prediction tools for acute coronary syndrome : a systematic review

[摘要] ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) whichmanifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death.Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deathsannually are caused by CVD (51% from strokes and 45% from coronary artery disease)worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annuallyfrom CVD, mainly in the form of strokes and heart disease. The WHO compared the deathrates of high-income countries to those of low- and middle-income countries, like SouthAfrica, and the results show that CVD deaths are declining in high-income countries butrapidly increasing in low- and middle-income countries. Although there are several riskprediction tools in use worldwide, to predict ischemic risk, South Africa does not use any ofthese tools. Current practice in South Africa to diagnose acute coronary syndrome is the useof a physical examination, ECG changes and positive serum cardiac maker levels.Internationally the same practice is used to diagnose acute coronary syndrome but riskassessment tools are used additionally to this practise because of limitations of the ECG andserum cardiac markers when it comes to NSTE-ACS.Objective: The aim of this study was to systematically appraise evidence on the accuracy ofacute coronary syndrome risk prediction tools in adults.Methods: An extensive literature search of studies published in English was undertaken.Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL.Other sources were also searched, and cross-sectional studies, cohort studies andrandomised controlled trials were reviewed. All articles were screened for methodologicalquality by two reviewers independently with the QUADAS-2 tool which is a standardisedinstrument. Data was extracted using an adapted Cochrane data extraction tool. Data wasentered in Review Manager 5.2 software for analysis. Sensitivity and specificity wascalculated for each risk score and an SROC curve was created. This curve was used toevaluate and compare the prediction accuracy of each test.Results: A total of five studies met the inclusion criteria of this review. Two HEART studiesand three GRACE studies were included. In all, 9 092 patients participated in the selectedstudies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants)were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEARTrisks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates ofsensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). Onthe SROC curve analysis, there was a trend for the GRACE risk score to perform better thanthe HEART risk score in predicting acute coronary syndrome in adults.Conclusion: Both risk scores showed that they had value in accurately predicting thepresence of acute coronary syndrome in adults. The GRACE showed a positive trendtowards better prediction ability than the HEART risk score.

[发布机构] Stellenbosch University