Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

James McCord, Henry Ford Health
Rafael Cabrera, Henry Ford Health
Bertil Lindahl
Evangelos Giannitsis
Kaleigh Evans, Henry Ford Health
Richard M. Nowak, Henry Ford Health
Tiberio M. Frisoli, Henry Ford Health
Richard Body
Michael Christ
Christopher R. deFilippi
Robert H. Christenson
Gordon Jacobsen
Aitor Alquezar
Mauro Panteghini
Dina Melki
Mario Plebani
Franck Verschuren
John French
Garnet Bendig
Silvia Weiser
Christian Mueller

Abstract

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.