Chest Pain Risk Stratification in the Emergency Department and Prediction of Major Adverse Cardiac Events Using HEART Score

Abstract

Introduction: Acute coronary syndrome (ACS) should be identified from various cardiac and noncardiac causes of chest pain. Non-ST segment elevation (NSTE-ACS) diagnosis can be done immediately in the case of typical changes in the electrocardiogram (ECG) and/or increased levels of myocardial markers, the absence of such variation does not always exclude NSTE-ACS. NSTE-ACS in its early stages difficult to diagnose. To stratify the risk of chest pain, aid early diagnosis, and prediction of outcome HEART score was designed. Components of the HEART score are history, ECG, age, risk factors, and troponin. The objectives of the study are risk stratification of chest pain in ED, prediction of MACE, validate the HEART Score in risk stratification of chest pain, and deciding on the discharge of patients. Materials and methods: This was a hospital-based, prospective study involving 220 patients who were admitted and discharged according to risk stratification using the HEART score. Patients are followed up over six weeks for prediction of MACE. MACE includes AMI, PCI, CABG, or death. The collected data were analysed with SPSS version 26.0, IBM Corp, Chicago, Illinois, USA. P value ≤.05 is considered as significant. Results: Out of 220 patients, 51 reached MACE. Low-risk HEART scores were seen in 25% of patients and No MACE occurred in these patients. Intermediate risk HEART scores were seen in 53% of patients and MACE occurred in 9.3% of patients. High-risk HEART scores were seen in 22% of patients and MACE occurred in 83% of patients. Conclusion: HEART score is helpful in risk stratification of chest pain in our study. It also aids in early diagnosis of intermediate and high-risk groups. HEART score also helps in decision-making to discharge patients. Thus, HEART score provides a quick and reliable prediction of outcomes in chest pain and should be used in ED.