Comparison of the HEART and HEARTS3 scores to predict major adverse cardiac events in chest pain patients at the emergency department

Introduction: The aim of this study was to determine the risk assessment of acute coronary syndrome and prediction of major adverse cardiac events by HEART (History, ECG, Age, Risk factors, Troponin) and HEARTS3 (HEART + 3S = Sex, Serial 2-h ECG, and Serial 2-h delta Troponin) scoring systems in patients admitted to the emergency department with chest pain. Methods: This is a single-center prospective cohort study. This study was conducted in patients admitted to the emergency department with chest pain, without ST-elevation myocardial infarction, who were 18 years or older, and agreed to participate in the study. The primary endpoint is the occurrence of major adverse cardiovascular events within 30 days. The receiver operating characteristic curve was used to assess the power of HEART and HEARTS3 scores to predict major adverse cardiovascular events. Results: The mean age of 239 patients was 47.91 ± 13.93 years and 72.4% (173) were male. Major adverse cardiovascular events developed in 20.1% (48) of the patients. The mean HEART and HEARTS3 scores of the patients with major adverse cardiovascular events (5.67 ± 1.46 and 9.38 ± 3.91, respectively) were both statistically and significantly higher than the scores of the patients without major adverse cardiovascular events (2.33 ± 1.44 and 2.22 ± 1.39; p = 0.001). The area under the curve values of HEART and HEARTS3 scores were found to be 0.943 (95% confidence interval: 0.905–0.968) and 0.990 (0.968–0.999), respectively. Conclusion: In our study, the power of HEARTS3 score to predict major adverse cardiovascular events was better in the risk assessment of acute coronary syndrome in patients admitted to the emergency department with chest pain compared to the HEART score. We think that patients with a low HEARTS3 score can be safely discharged from emergency department without further cardiac examination.

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Adverse Cardiac Events in Emergency Department Patients with Chest Pain Six Months after a Negative Inpatient Evaluation for Acute Coronary Syndrome

Academic Emergency Medicine ◽

10.1197/aemj.9.9.896 ◽

2002 ◽

Vol 9 (9) ◽

pp. 896-902 ◽

Cited By ~ 11

Author(s):

A. F. Manini

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

Emergency Department Patients

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Abstract 2618: Use of Myeloperoxidase in Chest Pain Evaluation in The Emergency Department

Circulation ◽

10.1161/circ.116.suppl_16.ii_580-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Martin Möckel ◽

Reinhold Müller ◽

Christian Lueders ◽

Janett Reiche ◽

Christian Müller ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin I ◽

Adverse Outcome ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

Automated Immunoassay ◽

Prognostic Power

Background Elevated levels of myeloperoxidase (MPO) have been reported to indicate adverse outcome in selected patients with chest pain and acute coronary syndrome (ACS) but no data exists on its value in the routine setting of an emergency department (ED). Patients and methods Initial MPO was assessed at admission in 432 consecutive patients presenting to the ED who were evaluated for an acute coronary syndrome. In a subset of 116 patients blood samples were also available after 6 and 12–36 hours. All patients were followed up for six weeks with respect to major adverse cardiac events (MACE) including death, re-admission for heart failure or ACS and unplanned repeat coronary revascularisation. MPO was measured using a fully automated immunoassay in development on the ARCHITECT® platform and its prognostic power was compared with serial cardiac troponin I using cut-offs of 198 pmol/L for MPO and 0.1 μg/L for troponin I. Results Incidence of MACE was 13% in this population. MPO was detectable in all samples with a median of 246.5 (range 18 – 4547) pmol/L at admission. MPO increased significantly after 6h and decreased again after 12–36h. In this low-risk population, initial MPO levels revealed a sensitivity (Sens) of 82.1% and a specificity (Spec) of 37.5% (p<0.0001) for MACE compared with 28.6% Sens and 81.1% Spec (p=0.09 n.s.) for initial troponin I. Sensitivity of both markers improved when available serial information was used (MPO: Sens 96.4, Spec 22.6, p<0.0001; troponin I: Sens 44.6%, Spec 76.1%, p<0.01). In serial troponin I negative patients (n=317), both, initial MPO (Sens 80.6%, Spec 42.7%, p<0.05) and serial MPO (Sens 93.5%, Spec 28.7%, p<0.01) still demonstrated significant discriminatory power. Conclusions MPO has independent prognostic value in unselected patients evaluated for ACS in the ED. However MPO levels vary widely over the first 24h hours and also lack specificity.

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Development of a Clinical Prediction Rule for 30-Day Cardiac Events in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.07.026 ◽

2012 ◽

Vol 59 (2) ◽

pp. 115-125.e1 ◽

Cited By ~ 89

Author(s):

Erik P. Hess ◽

Robert J. Brison ◽

Jeffrey J. Perry ◽

Lisa A. Calder ◽

Venkatesh Thiruganasambandamoorthy ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Cardiac Events ◽

Coronary Syndrome ◽

Emergency Department Patients

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Comparative Prospective Study of the Performance of Chest Pain Scores and Clinical Assessment in an Emergency Department Cohort in Singapore

10.21203/rs.3.rs-51171/v1 ◽

2020 ◽

Author(s):

Ng Mingwei ◽

Hong Jie Gabriel Tan ◽

Fei Gao ◽

Jack Wei Chieh Tan ◽

Swee Han Lim ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Clinical Assessment ◽

Clinical Judgment ◽

Low Risk ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Pain Scores ◽

Pain Patients

Abstract Background Chest pain scores allow emergency physicians to identify low-risk patients for whom discharge can be safely expedited. While their utility have been extensively studied and validated in Western cohorts, data in patients of Asian heritage is lacking. This study aimed to determine the accuracy of HEART, EDACS and GRACE in risk-stratifying which emergency patients with chest pain or angina-equivalent symptoms are at risk of major adverse cardiovascular events (MACE) within 30 days (composite of all-cause mortality, acute myocardial infarction, and coronary revascularization). This single-centre prospective cohort-study enrolling 1200 patients was conducted by a large urban tertiary centre in Singapore. The chest pain scores were reported prior to disposition by research assistants blinded to the physician’s clinical assessment. Outcome adjudication was performed by an independent blinded cardiologist and emergency physician, while a second cardiologist adjudicated in the case of discrepancies. \Results Of 1200 patients enrolled, 5 withdrew consent and were excluded from analyses. 135 patients (11.3%) suffered MACE within 30 days. HEART, which ruled-out acute coronary syndrome in 52.8% of patients with 88.1% sensitivity, and EDACS, which ruled-out acute coronary syndrome in 57.5% of patients with 83.7% sensitivity, proved comparable to clinical judgment which ruled-out acute coronary syndrome in 73.0% of patients with 85.5% sensitivity. GRACE was weaker – ruling-out acute coronary syndrome in 79.2% of patients but with a dismal sensitivity of 45.0%. The correlation-statistic for HEART (79.4%) was also superior to EDACS (69.9%) and GRACE (69.2%). Conclusions HEART more accurately identified low-risk chest pain patients in an Asian emergency department who were suitable for expedited discharge and demonstrated comparable performance characteristics to clinical judgment. This has major implications on the use of chest pain scores to safely expedite disposition decisions for low-risk chest pain patients in the emergency department.

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The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-018-0816-4 ◽

2018 ◽

Vol 7 (1) ◽

Cited By ~ 5

Author(s):

Christopher Byrne ◽

Cristian Toarta ◽

Barbra Backus ◽

Tim Holt

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Acute Coronary Syndrome ◽

Meta Analysis ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Heart Score ◽

Coronary Syndrome ◽

Adverse Cardiac Events

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Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

CJEM ◽

10.1017/cem.2016.336 ◽

2016 ◽

Vol 19 (1) ◽

pp. 18-25 ◽

Cited By ~ 4

Author(s):

Marcus Eng Hock Ong ◽

Ying Hao ◽

Susan Yap ◽

Pin Pin Pek ◽

Terrance Siang Jin Chua ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Coronary Artery ◽

Artery Bypass ◽

Early Discharge ◽

Cardiac Events ◽

Urban Centre ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

Pain Patients

AbstractObjectivesThe new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED.MethodsThis prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment.ResultsThe study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%.ConclusionWe found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events.

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HEART score performance in Asian and Caucasian patients presenting to the emergency department with suspected acute coronary syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617700870 ◽

2017 ◽

Vol 7 (7) ◽

pp. 591-601 ◽

Cited By ~ 6

Author(s):

Vince C de Hoog ◽

Swee Han Lim ◽

Ingrid EM Bank ◽

Crystel M Gijsberts ◽

Irwani B Ibrahim ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Ethnic Groups ◽

Cardiovascular Events ◽

Low Risk ◽

Major Adverse Cardiovascular Events ◽

Risk Category ◽

Heart Score ◽

Coronary Syndrome ◽

Risk Categories

Background: The HEART score is a simple and effective tool to predict short-term major adverse cardiovascular events in patients suspected of acute coronary syndrome. Patients are assigned to three risk categories using History, ECG, Age, Risk factors and Troponin (HEART). The purpose is early rule out and discharge is considered safe for patients in the low risk category. Its performance in patients of Asian ethnicity is unknown. We evaluated the performance of the HEART score in patients of Caucasian, Chinese, Indian and Malay ethnicity. Methods: The HEART score was assessed retrospectively in 3456 patients presenting to the emergency department with suspected acute coronary syndrome (1791 Caucasians, 1059 Chinese, 344 Indians, 262 Malays), assigning them into three risk categories. Results: The incidence of major adverse cardiovascular events within six weeks after presentation was similar between the ethnic groups. A smaller proportion of Caucasians was in the low risk category compared with Asians (Caucasians 35.8%, Chinese 43.5%, Indians 45.3%, Malays 44.7%, p<0.001). The negative predictive value of a low HEART score was comparable across the ethnic groups, but lower than previously reported (Caucasians 95.3%, Chinese 95.0%, Indians 96.2%, Malays 96.6%). Also the c-statistic for the HEART score was not significantly different between the groups. Conclusions: These results show that the overall performance of the HEART score is equal among Caucasian and Asian ethnic groups. The event rate in the low risk group, however, was higher than reported in previous studies, which queries the safety of early discharge of patients in the low risk category.

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