title: Short- and Long-Term Prognostic Utility of the HEART Score in Patients Evaluated in the Emergency Department for Possible Acute Coronary Syndrome.
abstract: The HEART score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (ACS) in the emergency department (ED). We sought to determine the short-term and long-term prognostic utility of the HEART score.
  
  
  
  A retrospective single-center analysis of 947 patients evaluated for possible ACS in the ED in 1999 was conducted. Patients were followed for major adverse cardiac events (MACEs) at 30 days: death, acute myocardial infarction, or revascularization procedure. All-cause mortality was assessed at 5 years. The HEART score was compared with the Thrombolysis in Myocardial Infarction (TIMI) score.
  
  
  
  At 30 days, 14% (135/947) of patients had an MACE: 48 deaths (5%), 84 acute myocardial infarctions (9%), and 48 (5%) revascularization procedures. The MACE rate in patients with HEART score ≤3 was 0.6% (1/175) involving a revascularization procedure, 9.5% (53/557) in patients with HEART score between 4 and 6, and 38% (81/215) with HEART score ≥7. The C-statistic for the HEART score was 0.82 and 0.68 for the TIMI score for predicting 30-day MACE (P < 0.05). Patients with HEART score ≤3 had lower 5-year mortality rate compared with those with TIMI score of 0 (10.6% vs. 20.5%, P = 0.02).
  
  
  
  The HEART score is a valuable risk-stratification tool in predicting not only short-term MACE but also long-term mortality in patients evaluated for possible ACS in the ED. The HEART score had a superior prognostic value compared with the TIMI score.
authors.affiliation: From the *Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan; †Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan; ‡Henry Ford Heart and Vascular Institute, Detroit, Michigan; and §Department of Biostatistics, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Tarun
authors.initials: T
authors.lastname: Jain
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: Michael
authors.initials: M
authors.lastname: Hudson
authors.forename: Tiberio
authors.initials: T
authors.lastname: Frisoli
authors.forename: Gordon
authors.initials: G
authors.lastname: Jacobsen
authors.forename: James
authors.initials: J
authors.lastname: McCord
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D000368:Aged; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors