Short-Term Prognostic Utility of Low, Intermediate, and High Heart Scores in Patients Presenting to the Emergency Department with Possible Acute Myocardial Injury
Noll S, Lawler S, McCord J, Hudson M, Moyer M, Jacobsen G, and Nowak R. Short-term prognostic utility of low, intermediate, and high heart scores in patients presenting to the emergency department with possible acute myocardial injury. Acad Emerg Med 2017; 24:S53.
Acad Emerg Med
Background: The HEART Score (HS) is a risk-stratification tool that predicts the risk of major adverse cardiac events (MACE) in patients evaluated for possible acute myocardial infarction (AMI) in the Emergency Department (ED). The score incorporates the patient's history, ECG, age, risk factors and cardiac troponin (cTn) level. We sought to determine the short-term prognostic utility of the HS in patients with low (0-3), intermediate (4-6) and high (7-10) HEART scores.
Methods: A prospective single-center analysis of 569 patients evaluated for possible AMI in the ED from May 2013 to April 2015 was conducted. Patients that had an ECG that led to immediate reperfusion therapy were excluded. Patients were followed for MACE (death/AMI) within 30 days. The diagnosis of AMI was adjudicated by 2 independent physicians in accordance with the universal definition of AMI, and required Siemens cTnI-Ultra value greater than 0.04 ng/ml. Results: At 30 days, 9.5% (54/569) of patients had a MACE (47 non-fatal AMIs, 2 fatal AMIs, and 5 non-AMI deaths). The MACE rate was 1.8% (6/326) in patients with a low HS, 18.0% (42/233) in patients with an intermediate HS, and 60.0% (6/10) in patients with a high HS (p < 0.001).
Conclusions: The HS was able to distinguish between low, intermediate, and high-risk patients evaluated for possible AMI in the ED. Patients deemed low risk for MACE based on HEART scores could be considered for early discharge from the ED safely.