Abstract 13686: HEART Score Predicts Coronary Artery Disease on Coronary Computed Tomography Angiography in the Emergency Department Only in Patients With Three or Greater Risk Factors

Abstract

Introduction: HEART (History, Electrocardiogram, Age, Risk factors, Troponin) Score (HS) predicts MACE in patients presenting to the ED with chest pain. It was validated clinically but not radiologically. Coronary computed tomography angiography (CCTA) in the ED allows for rapid triaging of patients and carries prognostic value. Objective: study relationship between HS and the presence and severity of CAD on CCTA. Methods: In this retrospective cohort, we included patients undergoing CCTA in the ED for acute chest pain between January 2014 to July 2016. HS was calculated and classified as low-risk (score <=3) or high-risk (score >3). A certified specialist reviewed all CCTA studies and determined the presence and severity of CAD. Anatomic CAD was defined by coronary artery calcium score (CACS) >0 or the presence of any stenosis. Obstructive CAD was defined by CACS>100 or coronary stenosis >=50%. Multivariate regression analysis was performed to determine predictors of anatomic and obstructive CAD. We performed interaction analysis between HS and the presence of >=3 traditional CAD risk factors. Results: Of the 927 CCTA performed, 315 (34%) had anatomic CAD, 128 (14%) had obstructive CAD. Mean age was 51 years, 49% were males, mean HS was 2.6, and 71% of the cohort had a low-risk HS. High HS was associated with higher proportions of CAD only in patients who had >=3 traditional CAD risk factors [Fig 1]. Regression and interaction analyses showed that HS was an independent predictor of anatomic and obstructive CAD only in patient with >=3 traditional CAD risk factors [Fig 2]. Conclusion: HS is a predictor of radiographic CAD on CCTA when performed in patients with >=3 traditional risk factors.