Chest pain in the emergency room: a multicenter validation of the HEART Score.
OBJECTIVE
Decision-making in chest pain patients is hampered by poor diagnostic power of patient's history, electrocardiogram, age, risk factors, and troponin. Each of these findings may be qualified with 0, 1, or 2 points. Together they compose the HEART score. We tested the hypothesis that the HEART score predicts major adverse cardiac events.


METHODS
Retrospective multicenter analysis in patients presenting at the cardiology emergency room.


METHODS
Patient inclusion between January 1 and March 31, 2006.


METHODS
A total of 2161 patients were admitted, of which 910 patients (42%) presented with chest pain. Analysis was performed in 880 cases (96.7%).


METHODS
The primary endpoint was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery and death, within 6 weeks after presentation, together called major adverse cardiac events.


RESULTS
A total of 158 patients (17.95%) reached the primary endpoint. Ninety-two patients had an acute myocardial infarction (10.45%), 82 a percutaneous coronary intervention (9.32%), 36 a coronary artery bypass graft (4.09%), and 13 died (1.48%). Of 303 patients with HEART score 0 to 3, three (0.99%) had an endpoint. In 413 patients with HEART score 4 to 6, 48 cases (11.6%) reached an endpoint. In case of a HEART score of 7 to 10, an endpoint was reached in 107/164 cases (65.2%).


CONCLUSIONS
The HEART score helps in making accurate diagnostic and therapeutic decisions without the use of radiation or invasive procedures. The HEART score is an easy, quick, and reliable predictor of outcome in chest pain patients and can be used for triage.
Backus
Barbra E
BE
Department of Cardiology, Universitair Medisch Centrum, Utrecht, Nieuwegein, The Netherlands.
Six
A Jacob
AJ
Kelder
Johannes C
JC
Mast
Thomas P
TP
van den Akker
Frederieke
F
Mast
E Gijis
EG
Monnink
Stefan H J
SH
van Tooren
Rob M
RM
Doevendans
Pieter A F M
PA
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards*; D042241:Early Diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T