Value of detecting HEARTS3 Score to improve risk stratification in patients with non-ST segment elevation chest pain in emergency department

Abstract

Objective To investigate the value of detecting HEART score and HEARTS3 score in risk stratification and prognosis of acute coronary syndrome (ACS) in patients with non-ST segment elevation chest pain in emergency department (ED). Methods Clinical data of case-control retrospective study of 775 patients with non-ST segment elevation chest pain in ED were collected from July 2011 to March 2015. The patients were estimated and risk stratification was made with HEART score and HEARTS3 score. After follow-up visiting by telephone for 30 days, outcomes were found to be ACS and myocardial infarction (MI). And the patients were categorized with score into low, intermediate and high risk groups .The correlation between the ACS and risk score in three groups was analyzed. Comparison of capability of performance in predicting 30-day ACS between the HEART score and HEARTS3 risk score. Statistical analyses were performed using SPSS13.0. Enumeration variables were expressed as percentage. For comparison of predictive value of the two sets of scores, area under the receiver operating curve (auROC) was calculated and compared by Z test. Results There were 92 cases with 30-day ACS. The rate of ACS had a trend of increase with increase in HEART score and HEARTS3 score. The patients with higher scores of HEART and HEARTS3, higher incidence of ACS in 30 days .Especially, the high-risk patients with score≥7 of HEART score and≥8 of HEARTS3 score had higher rate of ACS. And there was significant difference in predicting high-risk patients between two sets of scoring (P<0.05). The HEARTS3 score outperformed the HEART score as determined by comparison of areas under the ROC curve for MI (0.952 vs 0.813; P=0.028), 30-day ACS (0.913 vs. 0.815; P=0.034). Conclusions HEART score and HEARTS3 score both can be used to evaluate and perform risk stratification for non-ST segment elevation chest pain patients in ED .But HEARTS3 score can more precisely stratify high-risk patients with chest pain for 30-day ACS. Key words: HEART score; HEARTS3 score; Chest pain; Risk Stratification; Acute Coronary Syndrome(ACS); Prognosis