Clinical Decision Rules and Predictive Scores

Clinical decision rules, such as the Goldman algorithm and the Acute Cardiac Ischaemia Time-insensitive Predictive Instrument (ACI-TIPI) have been developed to risk-stratify emergency department patients presenting with chest pain.

Other risk-stratification tools, such as the TIMI or GRACE scores, have been developed in populations with acute coronary syndrome, but subsequently used in heterogeneous populations with chest pain. Despite extensive research, the clinical utility of these scores remains unclear.


Components of the TIMI score:

  • Age >= 65 years
  • Previous coronary artery stenosis >50%
  • Three or more risk factors for coronary heart disease
  • ST segment deviation
  • Aspirin use in the preceding 7 days
  • Two or more anginal events in the last 24 hours
  • Elevated cardiac biomarkers


Components of the GRACE score:

  • Age
  • Heart rate
  • Systolic blood pressure
  • Creatinine
  • Killip class
  • Cardiac arrest at presentation
  • ST segment deviation
  • Elevated cardiac markers
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