A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

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 x2 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.