To determine the prognostic accuracy of the HEART score as a predictor for major adverse cardiac events in patients presenting with chest pain to emergency department in a tertiary care hospital

Abstract

INTRODUCTION: One of the main causes of sudden cardiac death in the emergency department is myocardial infarction. Although there are several scores that helped predict an identified acute coronary incident, there was no quantitative tool available to risk stratifying patients with chest pain to support more decisions. The study is aimed to determine the prognostic accuracy of the HEART score as a predictor for major adverse cardiac events in patients presenting with chest pain to the emergency medicine department (ED). MATERIAL AND METHODS: Study included 83 adult patients presenting with Acute Myocardial Infarction who had chest pain attending to the ED were studied their HEART score to predict major adverse cardiac events. RESULTS: 60.24% of males and 39.76% of females with mean age of 57.83 ± 12.85 years were presented to ED. 44.56% had hypertension, 46.99% of diabetes mellitus, 21.69% of smoking, 16.87% of alcoholism, 4.82% of obesity, and 3.61% of patients with family history of cardiac diseases. 28.92% had non-specific repolarization, and 33.73% of patients had significant ST-Depression. According to Heart score, 26.51% of patients had low risk, 39.76% of patients had moderate risk, and 33.73% of patients had high risk. More percentage of male patient’s (67.9%) were in the high risk group of heart score than females (32.1%). ST-Depression cases were more in the high risk group (85.7%), and statistical significant association seen between ECG and the heart score (P<0.0001). among risk factors, Hypertension and Diabetes mellitus patients was more in the high risk groups with 48.6%, and 53.8% (P=0.001). 100% of high risk cases had ≥3 x normal limit of troponin, and there was a statistically association seen between troponin and heart score (P<0.0001). Diagnosis of HEART score of the low risk group showed that the risk factor had significantly higher AUC value (AUC = 0.801) than the age group (AUC = 0.778), history (AUC = 0.747), Troponin (AUC = 0.738), and ECG (AUC = 0.722). Out of 22 cases of the low risk group, 6 of Unstable angina (UA), 16 of NSTEMI, 4 of Percutaneous coronary intervention (PCI), 2 CABG, and 1 cardiovascular (CV) death. For moderate risk group (n=33), 13 of UA, 17 of NSTEMI, 3 of STEMI, 20 of PCI, 14 of CABG, and 12 of CV deaths. For high risk group (n=28), 10 UA, 14 of NSTEMI, 3 of STEMI, 9 of PCI, 6 of CABG, and 4 number of CV death. CONCLUSIONS: It was concluded that the HEART score should be used as the primary clinical decision tool for the risk stratification and a good predictor of major adverse cardiac events in patients presenting with chest pain to the emergency department to promote their safe and efficient nature in a community hospital setting