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The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm

Marcia Cortés1, Sohaib Haseeb2, Florencia Lambardi1

  • 1Cardiology Department, Instituto Cardiovascular de Buenos Aires, Argentina.

European Heart Journal. Acute Cardiovascular Care
|October 29, 2019
PubMed

Insights

The European Society of Cardiology's 0/1-hour algorithm and HEART score effectively triage chest pain patients. The HEART score better identifies low-risk patients for major adverse cardiac events.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Triage

Background:

  • The European Society of Cardiology (ESC) 0/1-hour algorithm aids in ruling out non-ST-segment elevation myocardial infarction (NSTEMI).
  • The HEART score is a validated tool for risk stratifying patients with chest pain.
  • Evaluating these tools in emergency department settings is crucial for patient management.

Purpose of the Study:

  • To compare the performance of the ESC 0/1-hour algorithm and the HEART score.
  • To assess their accuracy in identifying low-risk patients presenting with chest pain suggestive of acute coronary syndrome.
  • To evaluate their effectiveness in predicting 30-day major adverse cardiac events (MACE).

Main Methods:

  • A prospective study involving 1355 consecutive emergency department patients with symptoms suggestive of non-ST-segment elevation acute coronary syndrome.
  • Application of both the ESC 0/1-hour algorithm and the HEART score for risk stratification.
  • Follow-up for 30 days to ascertain rates of NSTEMI and MACE (death, NSTEMI, or unplanned coronary revascularization).

Main Results:

  • The ESC algorithm identified 68.0% as "rule-out," while the HEART score classified 50.6% as "low-risk."
  • 30-day NSTEMI incidence was similar: 0.32% for ESC "rule-out" vs. 0.29% for HEART "low-risk" (p=0.75).
  • MACE rates significantly differed: 7.7% for ESC "rule-out" vs. 1.1% for HEART "low-risk" (p<0.001).

Conclusions:

  • The ESC 0/1-hour algorithm effectively identifies a larger proportion of patients at low risk for NSTEMI.
  • The HEART score demonstrates superior capability in identifying patients at low risk for major adverse cardiac events.
  • Both tools are valuable, but the HEART score offers better risk stratification for MACE in this population.
Abstract

Keywords:
Chest painEuropean Society of Cardiology 0/1-hour algorithmHEART score

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