Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department-Reference-Cited by-同舟云学术

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Published:2017-02 Issue:2 Volume:10 Page:
ISSN:1941-7713
Container-title:Circulation: Cardiovascular Quality and Outcomes
language:en
Short-container-title:Circ: Cardiovascular Quality and Outcomes

Author:

McCord James¹,Cabrera Rafael¹,Lindahl Bertil¹,Giannitsis Evangelos¹,Evans Kaleigh¹,Nowak Richard¹,Frisoli Tiberio¹,Body Richard¹,Christ Michael¹,deFilippi Christopher R.¹,Christenson Robert H.¹,Jacobsen Gordon¹,Alquezar Aitor¹,Panteghini Mauro¹,Melki Dina¹,Plebani Mario¹,Verschuren Franck¹,French John¹,Bendig Garnet¹,Weiser Silvia¹,Mueller Christian¹,Twerenbold Raphael²,Katus Hugo A.³,Popp Steffen⁴,Ordóñez-Llanos Jorge⁵,Santalo-Bel Miquel⁵,Horner Daniel⁶,Dolci Alberto⁷,Jernberg Tomas⁸,Zaninotto Martina⁹,Manara Alessandro¹⁰,Dinkel Carina¹¹,Menassanch-Volker Sylvie¹²,Jarausch Jochen¹³,Zaugg Christian¹²,

Affiliation:

1. From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System,...

2. Department of Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland

3. University of Heidelberg, Heidelberg, Germany

4. Department of Emergency and Critical Care Medicine, Klinikum Nuremberg, Nuremberg, Germany

5. Department of Emergency Medicine, Institut d’Investigacions Biomèdiques Sant Pau, Barcelona, Spain

6. The University of Manchester, Manchester, UK

7. University of Milan Meical School, Milan, Italy

8. Department of Medicine, Karolinska Institutet, Huddinge, Sweden

9. University Hospital of Padova, Padua, Italy

10. Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium

11. Roche Diagnostics Germany, Penzberg, Germany

12. Roche Diagnostics International Ltd, Rotkreuz, Switzerland

13. Roche Diagnostics Germany (formerly), Penzberg, Germany

Abstract

Background— The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Methods and Results— Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs ( P =0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs ( P =0.03). Conclusions— Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Link

https://www.ahajournals.org/doi/pdf/10.1161/CIRCOUTCOMES.116.003101

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