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.
Highlights
Chest pain is one of the most common presentations in the emergency department (ED), about 6.3% of ED visits [1]
We evaluated the relationships of our study variables with major adverse cardiac events (MACE) score
Analytical results of our study showed that the mean thrombolysis in myocardial infarction (TIMI) score in patients with the endpoint of MACE happening was 1.8 times more than the score in negative MACE
Summary
Chest pain is one of the most common presentations in the emergency department (ED), about 6.3% of ED visits [1]. There is a great deal of differential diagnosis when facing a patient with the chest pain, acute coronary syndrome (ACS), pulmonary emboli, vascular events, and noncardiac presentations [2,3]. It is evident that less than 25% of all chest pain patients have truly ACS [4]. It has been reported that almost 2%-4% of AMI patients are being discharged from ED without the correct diagnosis. This is one of the major judicial and legal issues for emergency physicians [10]
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