Does an imaging stress-test adds information to prognostic scores in patients with chest pain in the emergency department?

Innocenti, Francesca; Luzzi, Margherita; Donnini, Chiara; Zanobetti, Maurizio; Tassinari, Irene; Caldi, Francesca; Pini, Riccardo

doi:10.1007/s11739-018-1882-2

Cited by 1 publication

(2 citation statements)

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“…On the contrary, it may increase the providers’ burden to further admit patients to in-hospital management with the potential redundant cardiac workup. A previous study found that combining the HEART score and patient’s stress test results improved diagnostic performance of 30-day MACE outcome [ 14 ]. However, no modified HEART score was derived from the study.…”

Section: Introductionmentioning

confidence: 99%

“…Modification and expansion of the current HEART score have been reported in previous studies [ 16 , 17 ]. Some studies kept several main HEART components and replaced others [ 17 , 18 ], while other studies added extra components on HEART score [ 14 , 16 ]. All these studies intended to increase the diagnostic and prognostic performance accuracy of the HEART score.…”

Section: Introductionmentioning

confidence: 99%

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Using HEART2 score to risk stratify chest pain patients in the Emergency Department: an observational study

Schrader

Kumar

Zhou

et al. 2022

BMC Cardiovasc Disord

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Background A significant number of chest pain patients had previous cardiac imaging tests (CIT) performed before being presented to the Emergency Department (ED). The HEART (history, electrocardiogram, age, risk factors, and troponin) score has been used to risk-stratify chest pain patients in the ED, but not particularly for patients with CIT performed. We aim to modify the current HEART score with the addition of most recent CIT findings (referred to as HEART2 score), to predict a 30-day major adverse cardiac event (MACE) among ED chest pain patients, compare the performance accuracy of using HEART versus HEART2 score for 30-day MACE outcome predictions, and further determine the value of HEART2 in a subset group of ED chest pain patients (i.e., ones with previous CIT). Methods This is a single-center observational study. We included chest pain patients with HEART scores calculated during their index ED visits. A modified HEART2 score was developed with the addition of CIT findings as one of the HEART2 components. Patients were divided into three groups, including low (≤ 3), moderate (4–6), and high-risk HEART/HEART2 scores (≥ 7). MACE occurrence of a patient with different risks of HEART and HEART2 scores and overall performance accuracy of HEART versus HEART2 score predicting MACE outcomes were compared. Results We included a total of 9419 chest pain patients at ED, among which one out of five patients (1874/9419) had previous CIT performed. Fewer (38.2%) of such patients had low-risk HEART scores in comparison to 55.5% of low-risk HEART2 scores (p < 0.001). The MACE outcomes were similar in low-risk HEART patients compared with low-risk HEART2 patients (2.2% versus 3.1%, p = 0.3021). The overall performance accuracy of using the HEART2 score to stratify chest pain patients with previous CIT was better than using the HEART score’s (AUC 0.74 versus 0.71, p = 0.0082). Conclusions Using the HEART2 score might be suitable to stratify low-to-moderate risk chest pain patients at ED with a similar 30-days MACE occurrence compared to the HEART score. More importantly, with the use of similar low-risk criteria (HEART2 ≤ 3), over 45% more chest pain patients with previous CIT performed could be discharged directly from ED.

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Section: Introductionmentioning

confidence: 99%