Comparison of acute coronary syndrome decision aids in the emergency department

Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score (EDACS), History, Electrocardiography, Age, Risk Factors, Troponin (HEART), and Thrombolysis in Myocardial Infarction (TIMI) in identifying low-risk acute coronary syndrome (ACS) patients and predicting 30-day major adverse cardiac events (MACE). Materials and Methods: This prospective study included patients aged ≥18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve (AUC) analysis. Results: Among 408 patients, 64 (15.7%) developed MACE. The HEART score had the highest AUC (0.823), followed by TIMI (0.784), EDACS-ADP (0.769), and EDACS (0.716). HEART had the highest sensitivity (90.6%) and negative predictive value (NPV; 97.2%). TIMI, at a ≤1 cut-off, had sensitivity of 81.3% and NPV of 94.7%; reducing the cut-off to