Clinical Gestalt and TIMI Risk Score in Predicting Major Cardiac Event in Patients with Chest Pain at Emergency Department

Background Chest pain is one of the leading complaints causing Emergency Department (ED) admissions. Approximately 25% of all ED visits are due to acute coronary syndrome (ACS). The TIMI risk score is a commonly and easily used bedside risk scoring method. Objective In this prospective observational study, the TIMI risk score and clinical gestalt were compared in terms of detecting a major adverse cardiac event (MACE) in patients presenting with chest pain at ED. Methods A total of 351 patients were evaluated by experienced clinicians in respect of the TIMI risk score (1-7 points) and clinical gestalt (in terms of low-, medium- and high-risk major adverse cardiac event). The primary outcome was a major adverse cardiac event within 14 days of presentation at ED. Results A major adverse cardiac event occurred within 14 days in 87 (24.7%) of 351 patients. The sensitivity of clinical gestalt was 93.10% (85.59%-97.43%), and the specificity of the TIMI risk score was 75.89% (71.33%-81.84%). The TIMI risk score and clinical gestalt were found to have similar results in detecting a major cardiac event (AUC: 0.75; AUC: 0.72). Conclusions The results of the present study showed that TIMI scoring and clinical gestalt detect any major adverse cardiac event at similar rates in patients presenting with chest pain at ED.