HEART-score can be simplified without loss of discriminatory power in patients with chest pain – Introducing the HET-score - 20/11/23
, Josephine Muhrbeck, Ph.D a, Kai M. Eggers, Ph.D b, Rickard Linder, Ph.D a, Lina Ljung, Ph.D c, Arne Martinsson, Ph.D d, Dina Melki, Ph.D e, Nondita Sarkar, Ph.D f, Per Svensson, Ph.D c, Bertil Lindahl, Ph.D b, Tomas Jernberg, Ph.D aAbstract |
Background |
The History, Electrocardiogram (ECG), Age, Risk factors and Troponin, (HEART) score is useful for early risk stratification in chest pain patients. The aim was to validate previous findings that a simplified score using history, ECG and troponin (HET-score) has similar ability to stratify risk.
Methods |
Patients presenting with chest pain with duration of ≥10 min and an onset of last episode ≤12 h but without ST-segment elevation on ECG at 6 emergency departments were eligible for inclusion. The HEART-score and the simplified HET-score were calculated. The endpoint was a composite of myocardial infarction (MI) as index diagnosis, readmission due to new MI or death within 30 days.
Results |
HEART-score identified 32% as low risk (0-2p), 47% as intermediate risk (3-5p), and 20% as high risk (6-10p) patients. The endpoint occurred in 0.5%, 7.3% and 35.7%, respectively. HET-score identified 39%, 42% and 19% as low- (0p), intermediate- (1-2p) and high-risk (3-6p) patients, with the endpoint occurring in 0.6%, 6.2% and 43.2%, respectively.
When all variables included in the HEART-score were included in a multivariable logistic regression analysis, only History (OR, CI [95%]): 2.97(2.16–4.09), ECG (1.61[1.14–2.28]) and troponin level (5.21[3.91–6.95]) were significantly associated with cardiovascular events. When HEART- and HET-score were compared in a ROC-analysis, HET-score had a significantly larger AUC (0.887 vs 0.853, p < 0.001).
Conclusions |
Compared with HEART-score, HET-score is simpler and appears to have similar ability to discriminate between chest pain patients with and without cardiovascular event.
Le texte complet de cet article est disponible en PDF.Highlights |
• | HET-score had a similar ability as HEART score in predicting prognosis in the ED |
• | Both among those without and with elevated troponin at presentation, HET-score had a similar ability as HEART-score to stratify individuals risk |
• | The score variable reflecting the troponin level had the strongest association with the risk of cardiovascular event |
• | Age and risk factors were significantly associated with a lower risk of events |
Keywords : Chest pain, Acute coronary syndrome, Score, Diagnosis, Prognosis
Abbreviations : Emergency Departments, acute coronary syndrome, electrocardiogram, left bundle branch block, high-sensitive Troponin, limit of detection, receiver operating curves, area under the curve, myocardial infarction, odds ratio, confidence interval
Plan
Vol 74
P. 104-111 - décembre 2023 Retour au numéro
Article précédent
- Sex differences in acute ischemic stroke presentation are a matter of infarct location
- Hannah M. Higgins, Lucia Chen, Brandy C. Ravare, Kerri A. Jeppson, Heather T. Bina, Paco S. Herson, Andrew A. Monte, Sharon N. Poisson, Layne Dylla
- Measurement of level of consciousness by AVPU scale assessment system based on automated video and speech recognition technology
- Dong Hyun Choi, Ki Jeong Hong, Sang Do Shin, Sungwan Kim, Minhwa Chung, Ki Hong Kim, Kyoung Jun Song, Minwoo Cho, Dan Yoon, Jooyoung Lee
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?