Evaluation Efficacy of HEART Score in Prediction of Major Advanced Cardiac Events in Patients with Chest Pain

Ehsan Bolvardi¹, Pooya Raoufi², Veda Vakili³, Hasan Jahed Taherani³, Mina Movaffaghi⁴,Mehran Bahramian⁵, and Koorosh Ahmadi^5*

¹Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

²Emergency Medicine Resident, Mashhad University of Medical Sciences, Mashhad, Iran.

³Social medicine Specialist, Mashhad University of Medical Sciences, Mashhad, Iran.

⁴Mashhad University of Medical Sciences, Mashhad, Iran.

⁵Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj,Iran.

Corresponding Author E-mail : kooroshem@gmail.com

DOI : http://dx.doi.org/10.13005/bbra/2126

ABSTRACT: Chest pain is one of the most common reasons for admitting patients to the emergency room. The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). Numerous risk prediction scores have been developed for fast and accurate risk stratification of chest pain in ED, like HEART score that a new ED Chest Pain risk stratification score. In this prospective cohort study, we aimed to evaluate efficacy of HEART score in prediction of 30 days major advanced cardiac events (MACE) in acute chest pain patients. A total of 100 unselected patients presented with acute chest pain at the cardiac emergency department of Emam Reza Hospital in Mashhad, from September 2015 until February 2016. The HEART score was assessed as soon as the first lab results and ECG were obtained. Endpoint was the occurrence of major adverse cardiac events (MACE) within 30 days. After 30-day follow-up, a total of 24 patients (24 %) reached one or more endpoints, AMI was diagnosed in 18 patients (18%), 2 patients (2%) underwent percutaneous coronary intervention (PCI), One (1%) had coronary artery bypass graft (CABG) surgery and 3 (3%) died. Independent predictors of MACE included age (P= 0.001). Hypertension was independent predictor of the combined end point only in female (P= 0.006). Age and troponin were independent predictors of the combined end point in both gender (Age P= 0.032 and Tpi P= 0.000). The average HEART score in the no end point group was 5.42 and in the patients with at least one end point was 7.42 (P=0.000). In low HEART scores (points 0–3), risk of MACE was 0%. In patients with HEART scores 4–6, MACE was diagnosed in 14.58%. In patients with high HEART scores (7–10), MACE occurred in 41.46%. In our study with increasing point of HEART score: sensitivity decreased, specifity increased and Positive predictive value increased. The HEART score helps in making accurate decisions at the emergency room without the use of invasive procedure. The HEART score is an easy, quick and reliable predictor of outcome in acute chest pain patients. It facilitates communication between doctors, especially when discussing the use of limited resources for chest pain patients. In this conditions who have higher HEART score points, choices may appear clear. This analysis suggests that HEART score can identify ED patients with acute chest pain for early discharge, as attention to high risk patients for admission for clinical observation, appropriate treatment including noninvasive testing and/or invasive strategies.

KEYWORDS: Acute Chest Pain; HEART score; Major Advance Cardiac Events

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