The HEART score in the era of the European Society of Cardiology 0/1-hour algorithm

Eur Heart J Acute Cardiovasc Care. 2020 Feb;9(1):30-38. doi: 10.1177/2048872619883619. Epub 2019 Oct 28.

Abstract

Background: The European Society of Cardiology's 0/1-hour algorithm improves the early triage of patients towards "rule-out" or "rule-in" of non-ST-segment elevation myocardial infarction. The HEART score is a risk stratification tool for patients with undifferentiated chest pain. We sought to evaluate the performance of the European Society of Cardiology 0/1-hour algorithm and the HEART score to evaluate chest pain patients in the emergency department.

Methods: In this prospective study, we applied the European Society of Cardiology 0/1-hour algorithm and the HEART score in 1355 consecutive patients who presented to the emergency department with symptoms suggestive of acute coronary syndrome without ST-segment elevation. Patients were followed for non-ST-segment elevation myocardial infarctions and major adverse cardiac events at 30 days: death, non-ST-segment elevation myocardial infarction, or unplanned coronary revascularization.

Results: The European Society of Cardiology 0/1-hour algorithm classified 921 (68.0%) patients as "rule-out" and the HEART score classified 686 (50.6%) patients as "low-risk". The 30-day incidence of non-ST-segment elevation myocardial infarctions was 0.32% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 0.29% in the HEART score "low-risk" patients (p=0.75). The rate of major adverse cardiac events was 7.7% in the European Society of Cardiology 0/1-hour algorithm "rule-out" patients versus 1.1% in the HEART score "low-risk" patients (p<0.001).

Conclusion: The European Society of Cardiology 0/1-hour algorithm identified more patients with low risk of non-ST-segment elevation myocardial infarctions at 30 days whereas for major adverse cardiac events, the HEART score had a greater capacity to detect low-risk patients.

Keywords: Chest pain; European Society of Cardiology 0/1-hour algorithm; HEART score.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / physiopathology
  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cardiology / organization & administration*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality
  • Chest Pain / diagnosis*
  • Electrocardiography / methods
  • Emergency Service, Hospital
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Non-ST Elevated Myocardial Infarction / blood
  • Non-ST Elevated Myocardial Infarction / diagnosis*
  • Non-ST Elevated Myocardial Infarction / physiopathology
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Prospective Studies
  • Research Design
  • Risk Assessment
  • Triage / methods
  • Troponin / blood

Substances

  • Troponin