External Validation of the Recalibrated HEART Score for Evaluation of Possible Acute Coronary Syndrome

Area of Science:

• Cardiology
• Emergency Medicine
• Diagnostic Performance

Background:

• Acute coronary syndrome (ACS) diagnosis in the emergency department (ED) requires efficient risk stratification.
• High-sensitivity troponin-T (hs-TnT) assays are crucial for detecting myocardial injury.
• The recalibrated History, Electrocardiogram, Age, Risk Factors, Troponin (rHEART) score aims to simplify ACS risk assessment.

Purpose of the Study:

• To validate the rHEART score using a single hs-TnT measurement for risk-stratifying ED patients with possible ACS.
• To investigate potential gender-specific differences in the performance of the rHEART score and hs-TnT thresholds.
• To assess the diagnostic performance for type-1 acute myocardial infarction (AMI) and major adverse cardiac events (MACE) within 30 days.

Main Methods:

• Secondary analysis of a prospective cohort study involving adult ED patients with possible ACS.
• Evaluation of the rHEART score with single (19 ng/L) and gender-specific (14 ng/L women, 22 ng/L men) hs-TnT thresholds.
• Analysis of diagnostic performance, including sensitivity and negative predictive values for AMI and MACE.

Main Results:

• The single-threshold rHEART score demonstrated high sensitivity (94.4%) and negative predictive value (99.3%) for MACE.
• Gender-specific thresholds performed similarly to the single threshold, indicating consistent utility across genders.
• Excluding patients presenting within 3 hours of symptom onset improved sensitivity for MACE and AMI.

Conclusions:

• A single hs-TnT measurement combined with the rHEART score is effective for risk-stratifying both male and female ED patients with possible ACS.
• The rHEART score shows similar performance for men and women, supporting its use in a multiethnic population.
• Optimal risk stratification is achieved when hs-TnT is drawn more than 3 hours after symptom onset.