A prospective validation of the HEART score for chest pain patients at the emergency department
A prospective validation of the HEART score for chest pain patients at the emergency department
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DOI：
10.1016/j.ijcard.2013.01.255
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发表时间：
2013-10-03
影响因子：
3.5
通讯作者：
Doevendans, P. A.
中科院分区：
文献类型：
--
作者：
Backus, B. E.;Six, A. J.;Doevendans, P. A.
背景：急诊科胸痛患者诊断过程的重点是识别急性冠脉综合征（ACS）的低危和高危患者。HEART评分旨在促进这一过程。本研究是对HEART评分的前瞻性验证。方法：在荷兰10家参与研究的医院的心脏急诊科，共有2440名未选择的胸痛患者。在获得第一次实验室结果和心电图后立即评估HEART评分。主要终点为6周内主要心脏不良事件（MACE）的发生。次要终点是(i) AMI的发生和死亡，（ii） ACS和（iii）冠状动脉造影的表现。将HEART评分与TIMI和GRACE评分进行比较。结果：36.4%的患者心脏评分低（0-3分）。MACE发生率为1.7%。在HEART评分4-6的患者中，诊断为MACE的患者占16.6%。在HEART评分较高（7-10）的患者中，MACE发生率为50.1%。HEART评分的c-统计量（0.83）显著高于TIMI评分（0.75）和GRACE评分（0.70）的c-统计量（p98%确定性）。对于这些病人，可以考虑采取保留政策。在HEART评分较高（7-10）的患者中，MACE的高风险可能意味着更积极的政策。2013爱思唯尔爱尔兰有限公司版权所有。
Background: The focus of the diagnostic process in chest pain patients at the emergency department is to identify both low and high risk patients for an acute coronary syndrome (ACS). The HEART score was designed to facilitate this process. This study is a prospective validation of the HEART score.Methods: A total of 2440 unselected patients presented with chest pain at the cardiac emergency department of ten participating hospitals in The Netherlands. The HEART score was assessed as soon as the first lab results and ECG were obtained. Primary endpoint was the occurrence of major adverse cardiac events (MACE) within 6 weeks.Secondary endpoints were (i) the occurrence of AMI and death, (ii) ACS and (iii) the performance of a coronary angiogram. The performance of the HEART score was compared with the TIMI and GRACE scores.Results: Low HEART scores (values 0-3) were calculated in 36.4% of the patients. MACE occurred in 1.7%. In patients with HEART scores 4-6, MACE was diagnosed in 16.6%. In patients with high HEART scores (values 7-10), MACE occurred in 50.1%. The c-statistic of the HEART score (0.83) is significantly higher than the c-statistic of TIMI (0.75) and GRACE (0.70) respectively (p98% certainty. In these patients one might consider reserved policies. In patients with high HEART scores (7-10) the high risk of MACE may indicate more aggressive policies. (C) 2013 Elsevier Ireland Ltd. All rights reserved.