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A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome
Chun-Peng Ma1, Xiao Wang2, Qing-Sheng Wang3
1Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiology, the First Hospital of Qinhuangdao, Hebei Medical University, Hebei, China.
Insights
A modified HEART score effectively assesses risk for major adverse cardiac events (MACE) in emergency department patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This validated tool aids in risk stratification and patient triage.
Area of Science:
- Cardiology
- Emergency Medicine
- Risk Stratification
Background:
- Chest pain is a common emergency department presentation.
- Accurate risk stratification is crucial for managing suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
- The HEART score is a validated tool for assessing cardiac risk.
Purpose of the Study:
- To validate a modified HEART risk score using high-sensitivity cardiac Troponin I.
- To assess the score's efficacy in patients with suspected NSTE-ACS in the emergency department.
- To evaluate the score's ability to predict major adverse cardiac events (MACE).
Main Methods:
- Retrospective cohort study utilizing a prospectively acquired database.
- Enrolled 1,300 chest pain patients with suspected NSTE-ACS in the emergency department.
- Calculated a modified HEART score using high-sensitivity cardiac Troponin I and assessed 3-month MACE (AMI, PCI, CABG, death).
Main Results:
- A modified HEART score showed a significant increasing trend in MACE with higher scores (P < 0.001).
- The area under the receiver operating characteristic curve was 0.84.
- Event rates were 1.1% for low risk (score 0-2), 18.5% for intermediate risk (score 3-4), and 67.0% for high risk (score 5-10).
Conclusions:
- The modified HEART risk score is validated for chest pain patients with suspected NSTE-ACS.
- This score can complement MACE risk assessment and patient triage in the emergency department.
- Further prospective studies are warranted to confirm these findings.
Objective:
To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).
Methods:
This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.
Results:
A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diagnosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progressive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 by χ (2) for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0-2), intermediate risk (score 3-4), and high risk (score 5-10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).
Conclusions:
The modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
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