Validation for the Diagnostic Use of the HEART Score in Patients With Acute Chest Pain in Japan

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Risk Stratification

Background:

• Clinical guidelines advocate risk scores for acute chest pain and suspected acute coronary syndrome (ACS).
• The History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score is a validated tool, but large-scale Japanese studies are limited.
• This study addresses the need for local validation of the HEART score in Japan.

Purpose of the Study:

• To validate the HEART score for predicting major adverse cardiovascular events (MACE) in Japanese patients with suspected ACS.
• To assess the safety of ruling out ACS in low-risk patients identified by the HEART score.
• To evaluate the impact of incorporating peak troponin levels on the HEART score's diagnostic utility.

Main Methods:

• Analysis of 487 patients presenting with chest pain to an emergency department (ED) between April and December 2022.
• Inclusion criteria: suspected ACS without ST-segment elevation or shock.
• Primary outcome: MACE within 30 days post-ED visit; secondary analysis included peak troponin levels.

Main Results:

• The HEART score demonstrated strong predictive value for MACE (Area Under the Curve [AUC] = 0.87).
• 140 patients (28%) with a HEART score ≤3 experienced no MACE within 30 days, indicating safe rule-out.
• Incorporating the highest troponin level into the HEART score calculation enhanced its diagnostic performance.

Conclusions:

• The HEART score is a reliable tool for predicting 30-day MACE in Japanese ED patients with chest pain.
• Patients with a HEART score of ≤3 can be safely excluded from having ACS.
• Optimizing the HEART score by including peak troponin levels improves its clinical utility for ACS risk stratification.