HEART Score Recalibration Using Higher Sensitivity Troponin T

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Acute cardiac syndrome (ACS) diagnosis relies on risk stratification scores.
• Current scores often use troponin thresholds at the 99th percentile.
• Optimizing these scores with updated troponin assays is crucial for patient management.

Purpose of the Study:

• To evaluate the diagnostic performance of recalibrated HEART and TIMI scores in suspected ACS.
• To compare the safety and discharge potential of recalibrated scores using high-sensitivity troponin T (hs-cTnT) with conventional methods.
• To assess the utility of a single hs-cTnT measurement at the limit of detection (LOD) or limit of quantification (LOQ).

Main Methods:

• A prospective cohort study in the UK, combined with secondary analyses of US cohorts.
• Recalibration involved shifting troponin thresholds from the 99th percentile to LOD/LOQ.
• Comparison of recalibrated HEART/TIMI scores against conventional scores and a single hs-cTnT < LOD/LOQ strategy.
• Primary outcome: 30-day major adverse cardiovascular events (MACE).

Main Results:

• Recalibrated HEART ≤ 3 demonstrated higher sensitivity (98.6%) for rule-out compared to conventional HEART ≤ 3 (96.1%).
• Recalibrated TIMI ≤ 1 also showed improved sensitivity (96.1%) versus conventional TIMI ≤ 1 (79.7%).
• A strategy using nonischemic ECG and hs-cTnT < LOD/LOQ achieved 99.1% sensitivity, with recalibrated HEART ≤ 3 potentially discharging 14% more patients.

Conclusions:

• A recalibrated HEART score ≤ 3 is a feasible and safe early discharge strategy for suspected ACS using single hs-cTnT.
• This recalibration enhances diagnostic accuracy and patient throughput.
• Further validation with diverse hs-cTn assays in independent cohorts is recommended before widespread implementation.