The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm

Abstract

Background: The European Society of Cardiology’s 0/1-hour algorithm improves the early triage of patients towards “rule-out” or “rule-in” of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department. Methods: In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization. Results: The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as “rule-out” and the HEART score classified 686 (50.6%) patients as “low-risk”. The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm “rule-out” patients versus 0.29% in the HEART score “low-risk” patients ( p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm “rule-out” patients versus 1.1% in the HEART score “low-risk” patients ( p<0.001). Conclusion: The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.

Development and validation of a risk score for chest pain with suspected non‐ST‐segment elevation acute coronary syndrome

“…However, the suitability of TIMI and GRACE scores remains debatable (Holly et al, 2013 ). MACS scores were developed for possible cardiac chest pain (Body et al, 2014 ), and the HEART score was developed specifically for suspected NSTE‐ACS (Alimohammadi et al, 2021 ; Backus et al, 2013 ; Cortés et al, 2020 ). The weightings of these scores were assigned without consideration for the prediction of adverse cardiac events.…”

A New Risk Score for Patients With Acute Chest Pain and Normal High Sensitivity Troponin

“…To explore the utility of the HARS score in clinical practice, patients were classified into low-, intermediate-, and high-risk groups according to the MACE rate (14-17). However, existing literature uses different boundaries for low-, intermediate-, and high-risk for patients with chest pain (3)(4)(5)(6)(7)(18)(19)(20)(21)(22)(23). In this study, we defined the boundaries of low, intermediate, and high risk as ≤2%, >2% but <20%, and ≥20%, respectively, based on the study population, events, and follow-up time.…”

“…Guidelines suggest using risk scores in the ED for early stratification of patients with acute ischemic chest pain and selecting different treatment strategies for different prognoses (2). Several risk scoring systems, such as the thrombolysis in myocardial infarction (TIMI), the Global Registry of Acute Coronary Events (GRACE), HEART, Sanchis, and Florence scores, have been developed to aid in the risk stratification of patients with suspected or diagnosed ACS (3)(4)(5)(6)(7)(8). The TIMI and GRACE scores were developed for patients with ACS, the HEART score was developed for patients with the suspected ACS, the Sanchis score was developed for patients with chest pain, non-ST segment deviation ECG and normal troponin levels (5), and the Florence score was developed for patients with acute chest pain without known coronary artery disease (CAD) and with normal ECG and troponin levels (7).…”

SCA-SSST na Emergência: Você Consegue Adivinhar o que está sob o Guarda-Chuva?

“…This is the outline in umbrella diagnoses, as is non-ST segment elevation (NSTE) Acute Coronary Syndromes (ACS). 2,3 There are a multitude of clinical tools in Cardiovascular Medicine [4][5][6] that aid physicians in the decision-making process, often surpassing the "educated guess" in acute settings. 7,8 However, the use of these tools in NSTE-ACS is particularly challenging for a number of reasons: Firstly, is this really NSTE-ACS?…”