Document Type : Original Article
Authors
1 Emergency Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Emergency Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition.
Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated.
Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2).
Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.
Keywords
Main Subjects
summary. Natl Health Stat Report 2010(26):1-31.
2. Bolvardi E, Raoufi P, Vakili V, Jahed Taherani H, Movaffaghi M, Bahramian M, et al. Evaluation efficacy of HEART score
in prediction of major advanced cardiac events in patients with chest pain. Biosci Biotechnol Res Asia 2016;13(2):999-
1005. doi:10.13005/bbra/2126
3. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008;16(6):191-6. doi:10.1007/bf03086144
4. Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL, et al. Testing of low-risk patients presenting
to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation
2010;122(17):1756-76. doi:10.1161/CIR.0b013e3181ec61df
5. Six AJ, Backus BE, Kingma A, Kaandorp SI. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department. Neth Heart J 2012;20(12):499-504.
doi:10.1007/s12471-012-0322-6
6. Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, et al. Coronary CT angiography
versus standard evaluation in acute chest pain. N Engl J Med 2012;367(4):299-308. doi:10.1056/NEJMoa1201161
7. National Clinical Guideline Centre for Acute and Chronic Conditions. Chest Pain of Recent Onset: Assessment and
Diagnosis of Recent Onset Chest Pain or Discomfort of Suspected Cardiac Origin. London: National Clinical
Guideline Centre for Acute and Chronic Conditions; 2010.
8. Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon 2008;54(9):593-603. doi:10.1016/j.disamonth.2008.06.003
9. Chan GW, Sites FD, Shofer FS, Hollander JE. Impact of stress testing on 30-day cardiovascular outcomes for lowrisk
patients with chest pain admitted to floor telemetry beds. Am J Emerg Med 2003;21(4):282-87. doi:10.1016/
s0735-6757(03)00080-9
10. Davis B. Rosen’s emergency medicine: Concepts and clinical practice. Prehospital Emergency Care 2004;8(3):334-5.
11. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable
angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284(7):835-
42. doi:10.1001/jama.284.7.835
12. Fox KA, Eagle KA, Gore JM, Steg PG, Anderson FA. The global registry of acute coronary events, 1999 to 2009--GRACE. Heart 2010;96(14):1095-101. doi:10.1136/hrt.2009.190827
13. Hermans WR, Foley DP, Rensing BJ, Rutsch W, Heyndrickx GR, Danchin N, et al. Usefulness of quantitative and
qualitative angiographic lesion morphology, and clinical characteristics in predicting major adverse cardiac events
during and after native coronary balloon angioplasty.CARPORT and MERCATOR Study Groups. Am J Cardiol
1993;72(1):14-20. doi:10.1016/0002-9149(93)90211-t
14. Keane D, Buis B, Reifart N, Plokker TH, Ernst JM, Mast EG, et al. Clinical and angiographic outcome following
implantation of the new less shortening wallstent in aortocoronary vein grafts: introduction of a second generation stent in the clinical arena. J Interv Cardiol 1994;7(6):557-64. doi:10.1111/j.1540-8183.1994.tb00496.x
15. Poldervaart JM, Langedijk M, Backus BE, Dekker IMC, Six AJ, Doevendans PA, et al. Comparison of the GRACE,
HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency
department. Int J Cardiol 2017;227:656-61. doi:10.1016/j.ijcard.2016.10.080
16. World Health Organization (WHO). The World Health Report 2002: Reducing Risks, Promoting Healthy Life.WHO; 2002.
17. Faxon DP, Creager MA, Smith SC Jr, Pasternak RC, Olin JW, Bettmann MA, et al. Atherosclerotic Vascular Disease Conference: executive summary: atherosclerotic Vascular Disease Conference proceeding for healthcare professionals from a special writing group of the American Heart Association. Circulation 2004;109(21):2595-604. doi:10.1161/01.cir.0000128517.52533.db
18. Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol 2013;12(3):121-6. doi:10.1097/HPC.0b013e31828b327e
19. Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, et al. A prospective validation of the HEART
score for chest pain patients at the emergency department. Int J Cardiol 2013;168(3):2153-8. doi:10.1016/j.
ijcard.2013.01.255
20. Sun BC, Laurie A, Fu R, Ferencik M, Shapiro M, Lindsell CJ, et al. Comparison of the HEART and TIMI risk scores for suspected acute coronary syndrome in the emergency department. Crit Pathw Cardiol 2016;15(1):1-5. doi:10.1097/hpc.0000000000000066
21. Jain T, Nowak R, Hudson M, Frisoli T, Jacobsen G, McCord J. Short- and long-term prognostic utility of the HEART
score in patients evaluated in the emergency department for possible acute coronary syndrome. Crit Pathw Cardiol
2016;15(2):40-5. doi:10.1097/hpc.0000000000000070
22. Backus BE, Six AJ, Kelder JH, Gibler WB, Moll FL,Doevendans PA. Risk scores for patients with chest pain: evaluation in the emergency department. Curr Cardiol Rev 2011;7(1):2-8. doi:10.2174/157340311795677662
23. Visser A, Wolthuis A, Breedveld R, ter Avest E. HEART score and clinical gestalt have similar diagnostic accuracy
for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED. Emerg Med J 2015;32(8):595-600. doi:10.1136/emermed-2014-203798
24. Chen XH, Jiang HL, Li YM, Chan CPY, Mo JR, Tian CW, et al. Prognostic values of 4 risk scores in Chinese patients with chest pain: prospective 2-centre cohort study. Medicine (Baltimore) 2016;95(52):e4778. doi:10.1097/md.0000000000004778
25. Manini AF, Dannemann N, Brown DF, Butler J, Bamberg F, Nagurney JT, et al. Limitations of risk score models
in patients with acute chest pain. Am J Emerg Med 2009;27(1):43-8. doi:10.1016/j.ajem.2008.01.022
)