Usefulness of the HEART Score with High-Sensitivity Troponin T for the Evaluation of Patients with Chest Pain

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Abstract

Background: The HEART score consists of a simple test designed to stratify patients who consult the emergency department for chest pain, according to their risk of presenting an acute coronary syndrome in the short term. It was initially created with a fourth-generation troponin, but the advent of high-sensitivity cardiac troponin T required its incorporation into the score and the re-evaluation of its behavior.

Objectives: The aim of this study was to evaluate the behavior of the HEART score with high sensitivity cardiac troponin T.

Methods: A prospective study was conducted including 1,464 patients who consulted at the emergency department due chest pain, with a non-ST-segment elevation electrocardiogram. The incidence of MACE (composite of acute myocardial infarction, death and revascularization) at 30 days was evaluated.

Results: The index classified 739 patients (50.5%) as low risk, 515 (35.2%) as intermediate risk and 210 (14.3%) as high risk patients. The composite of acute myocardial infarction, death and revascularization incidence was 1.35% in the first group, 20%, in the second group and 71%, in the third group (log-rank test p<0.001). The area under the global curve for the composite of acute myocardial infarction, death and revascularization was 0.91 (0.89-0.93).

Conclusions: The HEART score using high-sensitivity cardiac troponin T has a great capacity to classify patients with chest pain according to their risk of presenting cardiovascular events in the short term.