Assessing modified HEART scores with high-sensitivity troponin for low-risk chest pain in the emergency department.

Abstract

The accuracy of using HEART (history, electrocardiogram, age, risk factors, and troponin) scores with high-sensitivity cardiac troponin (hs-cTn) to risk stratify emergency department (ED) chest pain patients remains uncertain. We aim to compare the performance accuracy of determining major adverse cardiac event (MACE) among three modified HEART (mHEART) scores with the use of hs-cTn to risk stratify ED chest pain patients. This retrospective single-center observational study included ED patients with suspected acute coronary syndrome who had HEAR scores calculated and at least one hs-cTnI result. Various hs-cTnI parameters, including 99th percentile upper reference limit (URL, i.e., positive, ≥ 53 ng/l for females and ≥ 78 ng/l for males), limit of quantitation (LoQ, i.e., negative: < 20 ng/l), and limit of detection (LoD, < 3 ng/l), were used to calculate a troponin score (T-score). Patients with a T-score of 0 or mHEART score of 0-3 were considered low risk. The study compared the accuracy of different mHEART scores in predicting 30-day and 180-day MACE outcomes. A total of 10,495 patients were included, with 337 (3.21%) and 647 (6.16%) experiencing 30-day and 180-day MACE. The 30-day MACE rates were 0.53%, 1.37%, and 2.00% for patients whose hs-cTnI was beyond the cutoffs of LoD, LoQ, and URL, respectively. However, when low risk was defined as an mHEART score of 0-3, the 30-day MACE rates ranged from 0.33 to 0.62% across different mHEART scores. The mHEART score for risk stratification of low-risk chest pain patients shows acceptable accuracy in predicting MACE outcomes.