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Chest Pain in the Emergency Room: A Multicenter Validation of the HEART Score

Backus, Barbra E. MD*; Six, A. Jacob MD, PhD; Kelder, Johannes C. MD; Mast, Thomas P.§; van den Akker, Frederieke§; Mast, E. Gijis MD; Monnink, Stefan H. J. MD, PhD; van Tooren, Rob M. MD**; Doevendans, Pieter A. F. M. MD, PhD*

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: September 2010 - Volume 9 - Issue 3 - p 164-169
doi: 10.1097/HPC.0b013e3181ec36d8
Original Article

Objective: Decision-making in chest pain patients is hampered by poor diagnostic power of patient's history, electrocardiogram, age, risk factors, and troponin. Each of these findings may be qualified with 0, 1, or 2 points. Together they compose the HEART score. We tested the hypothesis that the HEART score predicts major adverse cardiac events.

Design: Retrospective multicenter analysis in patients presenting at the cardiology emergency room.

Setting: Patient inclusion between January 1 and March 31, 2006.

Patients: A total of 2161 patients were admitted, of which 910 patients (42%) presented with chest pain. Analysis was performed in 880 cases (96.7%).

Main Outcome Measures: The primary endpoint was a composite of acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft surgery and death, within 6 weeks after presentation, together called major adverse cardiac events.

Results: A total of 158 patients (17.95%) reached the primary endpoint. Ninety-two patients had an acute myocardial infarction (10.45%), 82 a percutaneous coronary intervention (9.32%), 36 a coronary artery bypass graft (4.09%), and 13 died (1.48%). Of 303 patients with HEART score 0 to 3, three (0.99%) had an endpoint. In 413 patients with HEART score 4 to 6, 48 cases (11.6%) reached an endpoint. In case of a HEART score of 7 to 10, an endpoint was reached in 107/164 cases (65.2%).

Conclusions: The HEART score helps in making accurate diagnostic and therapeutic decisions without the use of radiation or invasive procedures. The HEART score is an easy, quick, and reliable predictor of outcome in chest pain patients and can be used for triage.

From the *Department of Cardiology, Universitair Medisch Centrum, Utrecht, Nieuwegein, The Netherlands; †Department of Cardiology, Hofpoort Ziekenhuis, Woerden, The Netherlands; ‡Department of R&D Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands; §Utrecht University, Utrecht, The Netherlands; ¶Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands; ∥Department of Cardiology, Reinier de Graaf Groep, Delft, The Netherlands; and **Department of Cardiology, MESOS-Antonius Ziekenhuis, Utrecht, The Netherlands.

Reprints: A. J. Six, MD, PhD, Hofpoort Ziekenhuis Woerden, Polanerbaan 2, 3447 GN Woerden, The Netherlands. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.