title: A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).
  
  
  METHODS
  This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.
  
  
  RESULTS
  A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diagnosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progressive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 by χ (2) for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0-2), intermediate risk (score 3-4), and high risk (score 5-10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).
  
  
  CONCLUSIONS
  The modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
authors.affiliation: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiology, the First Hospital of Qinhuangdao, Hebei Medical University, Hebei, China.
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Ma
authors.affiliation: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiology, the First Hospital of Qinhuangdao, Hebei Medical University, Hebei, China.
authors.forename: Qing-Sheng
authors.initials: QS
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, the First Hospital of Qinhuangdao, Hebei Medical University, Hebei, China.
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Liu
authors.affiliation: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: He
authors.affiliation: Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Shao-Ping
authors.initials: SP
authors.lastname: Nie
keywords: Acute coronary syndrome; Chest pain; Emergency; Risk assessment; Troponin I