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Improving risk stratification in patients with chest pain: the Erlanger HEARTS3 score

Francis M Fesmire1, Erik J Martin, Yu Cao

  • 1Department of Emergency Medicine, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN 37403, USA. francis.fesmire@erlanger.org

The American Journal of Emergency Medicine
|May 26, 2012
PubMed

Insights

The HEARTS(3) score improves acute coronary syndrome (ACS) prediction in chest pain patients by refining the HEART score with additional variables and precise weighting. This new score offers more reliable risk stratification for 30-day ACS events.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Risk Stratification

Background:

  • The HEART score aids in predicting acute coronary syndromes (ACS) using patient history, ECG, age, risk factors, and troponin.
  • Existing HEART score elements may not be optimally weighted for accurate risk assessment.

Purpose of the Study:

  • To introduce and evaluate the HEARTS(3) score, an enhanced risk stratification tool for chest pain patients.
  • To improve the prediction of 30-day ACS by incorporating Sex, Serial 2-hour ECG, and Serial 2-hour delta troponin.

Main Methods:

  • Retrospective analysis of 2148 patients with non-ST-segment elevation chest pain.
  • Likelihood ratio analysis to determine optimal weighting for HEARTS(3) score components.
  • Primary outcomes: 30-day ACS and myocardial infarction.

Main Results:

  • The HEARTS(3) score demonstrated superior performance compared to the HEART score in predicting myocardial infarction (AUC 0.958 vs 0.825) and 30-day ACS (AUC 0.901 vs 0.813).
  • Likelihood ratio analysis identified significant discrepancies in the weighting of shared HEART and HEARTS(3) score elements.

Conclusions:

  • The HEARTS(3) score reliably risk stratifies patients presenting with chest pain for 30-day ACS.
  • Further prospective studies are recommended to validate the HEARTS(3) score as a clinical decision support tool for treatment and disposition.
Abstract

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