Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score

Abstract

BackgroundFast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories. We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess the prognostic value of Manchester triage system and of HEART score.MethodsRetrospective observational study including patients admitted to the ED of a tertiary hospital with chest pain as the presenting symptom. The primary outcome was a composite of all-cause mortality, myocardial infarction or unscheduled revascularization at 6 weeks.ResultsWe enrolled 233 patients (age 58 ± 19; 55.4 % males). The most common final diagnosis was non-specific chest pain (n = 86, 36.9 %), followed by ACS (n = 22, 9.4 %). Male gender, smoking and chronic kidney disease were associated with higher risk of ACS. According to Manchester triage system, chest pain patients stratified with red or orange priority had a higher incidence of ACS (16.5 % vs. 3.8 %, p = 0.006). The application of HEART score showed that most patients were in low risk category (56.3 %). The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001). HEART score accurately predicted the short-term incidence of MACE in chest pain patients (c-statistic 0.880; 95 % CI, 0.807–0.950, p < 0.001).ConclusionsChest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

Evaluation of The Patients Discharged from Emergency Department with Non-specific Chest Pain

“…In the study of Leite et al (5), additional diseases such as hypertension (in 50.7%), diabetes (in 11.8%), coronary artery disease (in 12.7%), atrial fibrillation (in 18.5%), heart failure (in 16.6%) and chronic pulmonary obstructive disease (in 7.6%) were present. In their study, Coşkun et al (7) found comorbid diabetes mellitus, coronary artery disease and hyperlipidemia in 13.6%, 26.8% and 4.1% of the patients, respectively.…”

“…In the literature, the mean ages were 56.9±19, 41.35±12.20 and 59.6±13.7 years (1,5,6). In these studies, 52.6%, 58.4% and 44.8% of the patients were male, respectively (1,6,7).…”

Which clinical scoring system should we use for the evaluation of chest pain in the Emergency Department? A review

“…By appreciating each of these five elements with 0, 1 or 2 each patient will receive a score of 0-10. The HEART score divides patients into low (0-3), intermediate (4)(5)(6) or high-risk groups (7-10), with mean risks of an event of 0.9, 12 and 65%, respectively. One limit of the TIMI and GRACE scores is that they have been originally developed for patients with confirmed ACS in the setting of coronary unit.…”

Sensibilidade e especificidade do Sistema Manchester de Classificação de Risco na priorização de pacientes com infarto agudo do miocárdio que apresentam dor torácica

“…Na primeira sessão foram apresentados os resultados da revisão sistemática e na segunda sessão foram apresentados os resultados do estudo primário conduzido no HU-USP. (50) ED (Hospital de nível terciário)…”

“…Como já mencionado, somente dois estudos (33,50) (28,49,51) , enquanto apenas um deles apresentou um limite superior do IC valor maior que 0,90 (50) . Entretanto, este estudo apresentou um intervalo de confiança bastante amplo, reduzindo seu peso dentro da revisão sistemática.…”