Blind Date without GRACE

Background: The emergency department (ED) has adopted the Canadian Triage and Acuity Scale (TAS) to evaluate all ED comers. However, Guidelines for initial evaluation of Acute Coronary Syndrome (ACS) and Non ST Evaluation Myocardial Infarction (NSTEMI) recommend usage of "cardiologic risk scale" such as the "Global Registry of Acute Coronary Events" (GRACE) for patients presenting with suspected ACS. A GRACE score >140 indicates high risk for worse outcome.

Aim: To evaluate adherence with guideline NSTEMI-ACS using TAS.

Methods: A retrospective study of 240 patients, which were discharged alive from a tertiary medical center with a diagnosis of NSTEMI.

Patients presenting with sudden death, shock or secondary NSTEMI were excluded. Data were collected from electronic medical records and the ED files were manually evaluated for quality measures: ECG within 10 minutes and Troponin results within an hour from arrival, accurate diagnosis of NSTEMI and initial medication with antiplatelets and heparin. GRACE score for all patients was retrospectively calculated and adherence with guideline was evaluated for two patients groups: above (>140pts) and below 140 (<140pts).

Results: GRACE score >140 was documented in 62% (148) of patients that were older (74.6±10.2 vs. 59±11.1 p<0.001) and had previous MI (69.6% vs. 46.7% p<0.001). Good adherence was lower for >140pts than for

Comment: The overall low adherences with NSTEMI-ACS guidelines calls for action. Using the TAS is not sensitive to detect high risk patients with NSTEMI-ACS and should be supplemented with cardiologic score such as GRACE. That may potentially increase guideline adherence.