Abstract

Background: Chest pain is one of the most common symptoms in patients visiting the emergency department (ED). Although the causes of chest pain are numerous, coronary heart disease is still one of the significant problems because it causes a high rate of hospitalization and mortality. The original HEART score was developed in Netherlands and utilized to stratify risk in chest pain patients as well as to identify the possibility of Major Cardiac Adverse Events (MACE) in 6 weeks. This study aimed to evaluate the modified HEART score, incorporating high sensitive troponin T measurement in patients with chest pain.

Methods: We used the data of patients who visited our Cardiology department, Hue University of Medicine and Pharmacy between June, 2022 and July, 2024. Patients aged ≥ 18 years old who presented with non-traumatic chest pain and undifferentiated chest pain were eligible fo the study. On the basis of the total score, the patients were stratified as low risk (modified HEART score of 0-3), intermediate risk (modified HEART score of 4-6) and high risk (modified HEART score of 7-10). The major adverse cardiac events (MACEs) that occurred within 8 weeks were investigated, and the diagnostic value and efficiency of modified HEART score was analyzed.

Results: Over the study period, 264 patients met inclusion criteria. During 8 weeks of follow up, 59 patients (22,3%) developed a MACE with 58 percutaneous coronary intervention (22%), 12 acute myocardial infarction (4,5%) and 4 deaths (1,5%). The modified HEART score in the patients with or without MACEs was 6,46 ± 1,37 and 4,71 ± 1,65 respectively. The incidence rates of MACEs in patients with low (0-3 points), intermediate (4-6 points) and high (7-10) risk were 2%; 18,9% and 50,9% in the modified HEART score analysis (p< 0,001), respectively. The sensitivity and specificity for 8 weeks MACE was 78,0% (95%CI: 34,5 – 89,8) and 66,3% (95%CI: 24,8 – 80,0), respectively with a cut-off value of 5,5 (p < 0,001).

Conclusion: The modified HEART score is valuable in risk stratification and prognostication of coronary artery disease events in chest pain patients.