Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department
McCord J, Cabrera R, Lindahl B, Giannitsis E, Evans K, Nowak R, Frisoli T, Body R, Christ M, deFilippi CR, Christenson RH, Jacobsen G, Alquezar A, Panteghini M, Melki D, Plebani M, Verschuren F, French J, Bendig G, Weiser S, Mueller C; TRAPID-AMI Investigators. Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department. Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2). pii: e003101.
Circ Cardiovasc Qual Outcomes
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.
METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).
CONCLUSIONS: Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
Medical Subject Headings
Adult; Aged; Algorithms; Angina Pectoris; Australia; Biomarkers; Cardiology Service, Hospital; Diagnosis, Differential; Emergency Service, Hospital; Europe; Female; Humans; Male; Middle Aged; Myocardial Infarction; Patient Discharge; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Troponin T; United States; Up-Regulation