Abstract
Introduction: Among the various scores studied in literature, the modified HEART score and HEART pathway were found to have high discriminatory power of predicting major adverse cardiac events (MACE) in Non ST elevation acute coronary syndrome (NSTEACS) patients in various international studies. This warrants need for evaluation of these scores for better management of patients in hectic emergency departments of Indian healthcare system. Methods: This prospective observational study was conducted between January 2021 and May 2022 in a tertiary care hospital of New Delhi, India. Modified HEART score was calculated based on history, ECG, age, risk factors and highly sensitive troponin I (hsTrop I) values for 60 patients. Collected serum samples of hsTrop I at 0 and 3 hours were measured using ELISA kits. As per the score, patients in low risk group were discharged safely and intermediate and high risk groups were assessed with the help of stress testing and coronary angiography and managed accordingly. The occurrence of MACE was assessed at 30 days from presentation to healthcare facility. Results: The study showed that proportion of patients with MACE was significantly higher in high risk group (82.14%) as compared to low (0%) and intermediate risk group (20.83%) (p value <0.001). Modified HEART score was the best predictor of MACE at cut off point of >6 with 88.1% chances of correctly predicting MACE. Negative predictive value of HEART pathway was found to be 100% which enabled safe disposition of low risk group patients. Conclusions: Hence, when modified HEART score and HEART pathway were used together, it allowed efficient use of resources and prediction of MACE in NSTEACS. This was the first study done on Indian population where modified HEART score and HEART pathway were used simultaneously to predict the occurence of MACE.
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