Assessing risk of major adverse cardiac events among patients with chest pain and cocaine use using the HEART score

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• Chest pain is a common emergency department presentation with potential for serious cardiac events.
• The HEART score aids in risk-stratifying patients for acute coronary syndrome (ACS) and major adverse cardiac events (MACE).
• The role of cocaine use as a risk factor within the HEART score remains debated.

Purpose of the Study:

• To investigate whether cocaine-positive patients have a higher risk of 30-day MACE compared to cocaine-negative patients.
• To evaluate the performance of the HEART score in patients with and without cocaine use.

Main Methods:

• Retrospective analysis of 46,210 adult patients presenting with chest pain across 13 emergency departments.
• Inclusion criteria: prospectively calculated HEART scores and urine toxicology tests.
• Comparison of 30-day MACE rates and HEART score performance (AUROC) between cocaine-positive (COP) and cocaine-negative (CON) groups.

Main Results:

• 1.4% of patients were cocaine-positive (COP).
• Despite higher mean HEART scores in COP patients, 30-day MACE rates were similar (1.1%) in both COP and CON groups.
• HEART score demonstrated reasonable overall performance (AUROC 0.72 for COP, 0.78 for CON), but the 'Risk Factor' component was poor for COP patients.

Conclusions:

• Cocaine use was not associated with an increased risk of 30-day MACE in chest pain patients.
• The HEART score is a valuable tool for risk stratification in this population, irrespective of cocaine use.
• Clinicians can confidently consider the HEART score for chest pain patients, including those who use cocaine.