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Chest pain in the emergency room: value of the new HEAR score identifying patients with low risk of acute coronary syndrome without troponin testing.
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Pommier Thibaut, Portella Eddy, Guilleminot Pierre, Goldstein Adrien, Laurent Gabriel, Guenancia Charles, Ray Patrick
Аннотация
BACKGROUND: Chest pain is a frequent reason for Emergency Department (ED) visits, although only a minority of patients ultimately present an Acute Coronary Syndrome (ACS). Current diagnostic strategies rely heavily on troponin testing, but a new clinical tool requiring no blood sampling, the HEAR score, has recently been proposed. This study aimed to evaluate the performance of the HEAR score for identifying low-risk patients presenting with chest pain, using 45-day Major Adverse Cardiovascular Events (MACE) as the primary outcome.
METHODS: All patients presenting with chest pain to the ED of Dijon University Hospital in 2019 were retrospectively analyzed in this single-center study. Patients were stratified as "low risk" (HEAR < 2) or "high risk" (HEAR ≥ 2). Outcomes assessed at 45-days included MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, and urgent coronary revascularization) and recurrence of ED consultation for chest pain.
RESULTS: Among 2177 patients presenting with chest pain, 1807 met inclusion criteria. Of these, 653 (36%) were classified as low risk (HEAR < 2). At 45-days, 22 (3%) low-risk patients reconsulted for chest pain compared with 64 (6%) in the high-risk group (p = 0.037). No MACE was identified among low-risk patients within the available follow-up data. The negative predictive value of a HEAR score < 2 was 100% (95% CI: 99.5%-100%), with an upper 95% confidence bound for the event rate of 0.46%.
CONCLUSION: A HEAR score < 2 identifies a substantial proportion of ED chest pain patients at very low risk of short-term adverse cardiovascular events. However, given the limitations of retrospective follow-up and potential under-ascertainment of events, these findings should be considered hypothesis-generating. The HEAR score may contribute to early clinical risk stratification rather than replace troponin-based strategies.
METHODS: All patients presenting with chest pain to the ED of Dijon University Hospital in 2019 were retrospectively analyzed in this single-center study. Patients were stratified as "low risk" (HEAR < 2) or "high risk" (HEAR ≥ 2). Outcomes assessed at 45-days included MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, and urgent coronary revascularization) and recurrence of ED consultation for chest pain.
RESULTS: Among 2177 patients presenting with chest pain, 1807 met inclusion criteria. Of these, 653 (36%) were classified as low risk (HEAR < 2). At 45-days, 22 (3%) low-risk patients reconsulted for chest pain compared with 64 (6%) in the high-risk group (p = 0.037). No MACE was identified among low-risk patients within the available follow-up data. The negative predictive value of a HEAR score < 2 was 100% (95% CI: 99.5%-100%), with an upper 95% confidence bound for the event rate of 0.46%.
CONCLUSION: A HEAR score < 2 identifies a substantial proportion of ED chest pain patients at very low risk of short-term adverse cardiovascular events. However, given the limitations of retrospective follow-up and potential under-ascertainment of events, these findings should be considered hypothesis-generating. The HEAR score may contribute to early clinical risk stratification rather than replace troponin-based strategies.