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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Modified HEART score to improve ruling out acute coronary syndrome at the emergency department

Eleonora Tubertini1, Mario Luca Morieri2, Gabriele Farina3

  • 1Emergency Department, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via P. Albertoni 15, 40138, Bologna, Italy. eleonora.tubertini@aosp.bo.it.

Internal and Emergency Medicine
|June 7, 2026
PubMed

Insights

The modified HEART (mHEART) score best identifies patients with chest pain in the emergency department who can be safely discharged. This score, when combined with high-sensitivity troponin testing, improves patient management and reduces major cardiovascular events.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Risk Stratification

Background:

  • Risk scores like the HEART score aid in safely discharging emergency department (ED) patients with chest pain.
  • A modified and simplified HEART score (mHEART) has been developed to enhance this process.

Purpose of the Study:

  • To prospectively validate the mHEART score's performance.
  • To compare the mHEART score against the classic HEART and GRACE scores for chest pain evaluation.

Main Methods:

  • A prospective observational study enrolled adult patients with non-traumatic chest pain in the ED.
  • GRACE, classic HEART, and mHEART scores were calculated for all patients.
  • The primary outcome was major cardiovascular events and overall mortality within 90 days (MACE).

Main Results:

  • The mHEART score demonstrated superior performance with a higher Area Under the Curve (AUC) of 0.891 compared to classic HEART (0.884) and GRACE (0.804).
  • mHEART identified 51% of patients at low risk with a 1.0% MACE incidence, similar to the classic HEART score (48% low risk, 1.0% MACE).
  • Combining mHEART with high-sensitivity troponin testing allowed safe discharge for nearly 50% of patients with a 0.5% MACE miss-rate.

Conclusions:

  • The mHEART score exhibits the best performance for ruling out acute coronary syndrome (ACS) in ED chest pain patients.
  • Integrating the mHEART score into current high-sensitivity troponin algorithms can optimize the management of chest pain presentations.
Abstract

Keywords:
Chest painEmergency departmentHEART scoreHigh sensitivity troponinRisk assessment

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