A Methodological Appraisal of the HEART Score and Its Variants Response

Predictive Value of the HEART Score Combined with Hypersensitive C-Reactive Protein for 30 d Adverse Cardiovascular Events in Patients with Acute Chest Pain

Purpose

This study aimed to explore the predictive value of the HEART score combined with hypersensitive C-reactive protein (hs-CRP) for 30 d major adverse cardiovascular events (MACEs) in patients with acute chest pain.

Methods

103 patients with acute chest pain admitted to the emergency department of our hospital from May 2020 to May 2022 were selected as the study subjects. The patients' HEART score and plasma hs-CRP level were recorded. The patients were followed up for 30 d to observe whether MACE occurred.

Results

Among 103 patients with acute chest pain, MACE occurred in 8 cases within 30 d of follow-up, and the probability of MACE was 7.76%. There was a statistically significant difference in 30 d MACE risk among patients with different HEART score stratification (P < 0.05). The age, HEART score, and hs-CRP levels of patients in the MACE group were higher than those in the non-MACE group (P < 0.05). The HEART score and the hs-CRP level were independent risk factors for 30 d MACE in patients with acute chest pain (P < 0.05). The AUC of the HEART score combined with hs-CRP in the occurrence of 30 d MACE in patients with acute chest pain was 0.901, which was significantly higher than 0.720 and 0.758 of single detection.

Conclusion

The HEART score combined with hs-CRP can better predict the occurrence of 30 d MACE in patients with acute chest pain.

Role of HEART score in prediction of coronary artery disease and major adverse cardiac events in patients presenting with chest pain

Introduction. Chest pain (CP) diagnostics accuracy remains debatable for both general practitioners (GP) or emergency department (ED) physicians for patients in HEART score (HS) low- and intermediate-risk groups which prompted us to review our electronic database for all patients admitted via our center?s ED during 2014 to 2020 for CP and suspect acute coronary syndrome. Methods. Patients were divided in function of low- or intermediate-risk HS and assessed during a three month follow up for angiogram results, MACE, lab results and echo parameters. Results. Of 585 patients included, low-risk HS group (21,4%, 36% were women) had significant coronary disease on angiogram in 68%, while for intermediate-risk HS group (78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area under the ROC curve of HS in detecting patients with ischemic heart disease as a cause of CP was 0.771 (95% CI:0.772-0.820) with best cut-off point HS was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6% respectively. Adjusting for sex, lab results and HS, AUROC curve of this model was 0.828 (95% CI:0.786-0.869; p < 0,0005) with cut-off of 77.95. Sensitivity and specificity were 84,9% and 68% respectively. In the three-month follow-up post-discharge, there was a significant difference in MACE between groups (low-vs. intermediate-risk HS was 3.4 vs. 16.7% p < 0.05). Conclusion. HS for our CP patients admitted via our ED by GP and ED physicians? referral, provides a quick and reliable prediction of ischemic heart disease and MACE.