Performance of the modified HEART score in an Asian population

Shanaz Matthew Sajeed,Amila Clarence Punyadasa,Dan Wei Jun Ong,Michael P De Dios

doi:10.1186/s12245-020-00300-1

Shanaz Matthew Sajeed, Amila Clarence Punyadasa + Show 2 more

Open Access

https://doi.org/10.1186/s12245-020-00300-1

Copy DOI

Abstract

IntroductionChest pain is the most common potentially life-threatening presentation to the emergency department (ED). Furthermore, the identification of acute coronary syndrome (ACS) including its risk stratification and subsequent disposition can be challenging. The original HEART score was derived as a predictive tool to risk stratify patients presenting with undifferentiated chest pain (CP) and aid physician decision-making. However, it utilized conventional troponins as its cardiac biomarker component. Our study aims to assess the utility of the modified HEART score with highly sensitive troponins in an Asian setting with mixed ethnicity to determine if it corroborates the findings of another recent Chinese study by Chun-Peng et al. (Journal of Geriatric Cardiology 13:64–69, 2016).MethodsClinical data from 413 patients presenting to the ED for evaluation of chest pain were analyzed. The predictive value of the modified HEART score for determining major adverse cardiac events (MACE) was then evaluated.ResultsA total of 49 patients (11.9%) had a MACE: 31 patients (7.5%) underwent PCI and 1 patient (0.2%) underwent CABG. There were 17 (4.1%) deaths.Three risk groups were elucidated based on MACE. In the low-risk group (0–2), there were 72 patients (17.4%), with a MACE rate of 1.4%. In the intermediate-risk group (3–5), there were 233 patients (56.4%), with a MACE rate of 5.2%. In the high-risk group (6–10), there were 108 patients (26.2%), with a MACE rate of 33.3%.ConclusionThe modified HEART score is an effective risk stratification tool in an ethnically diverse Asian population. Furthermore, it identifies low-risk patients who are candidates for early discharge from a local emergency department.

Highlights

Chest pain is the most common potentially life-threatening presentation to the emergency department (ED)
Three risk groups were elucidated based on major adverse cardiac event (MACE)
Amongst patients who present to the emergency department (ED) with chest pain, the difficulty lies in distinguishing cardiac from non-cardiac chest pain

Summary

Introduction

The original HEART score was derived as a predictive tool to risk stratify patients presenting with undifferentiated chest pain (CP) and aid physician decision-making. It utilized conventional troponins as its cardiac biomarker component. The diagnosis of ACS is based on history, ECG findings, and biochemical markers such as troponins Elements of these have been incorporated into numerous scoring systems. Registry of Acute Coronary Events (GRACE) are commonly used Their utility in discriminating cardiac from non-cardiac causes of chest pain is poor [2, 3]. The challenge, remains for the emergency physician to diagnose ACS

Objectives

Methods

Results

Conclusion