HEART score to further risk stratify patients with low TIMI scores

Shannon Marcoon, Anna Marie Chang, Betsy Lee, Rama Salhi, Judd E. Hollander

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: The ability to risk stratify patients presenting to the emergency department (ED) with potential acute coronary syndrome (ACS) is critical. The thrombolysis in myocardial infarction (TIMI) risk score can risk stratify ED patients with potential ACS but cannot identify patients safe for ED discharge. The symptom-based HEART score identifies very low-risk patients. Our hypothesis was that patients with a TIMI score of 0 or 1 may be stratified further with the HEART score to identify a group of patients at less than 1% risk of 30-day cardiovascular events. Methods: We conducted a secondary analysis of a prospective cohort study in a tertiary care hospital ED. Patients with potential ACS who were >30 years of age were included. Data collected included demographics, history, electrocardiogram, laboratories, and components of the TIMI and HEART scores. Follow-up was conducted by structured record review and phone. The main outcome was a composite of death, acute myocardial infarction, or revascularization at 30 days. Results: There were 8815 patients enrolled (mean age, 52.8 ± 15.1 years; 57% women, and 69% black). At 30 days, the composite event rate was 8.0% (660 patients): 108 deaths, 410 acute myocardial infarction, and 301 revascularizations. Of the 485 patients with both a TIMI score of 0 and a HEART score of 0, there were no cardiovascular events (95% confidence interval, 0-0.8%); but no other score combination had an upper limit confidence interval less than 1%. Conclusion: At all levels of TIMI score, the HEART score was able to further substratify patients with respect to 30-day risk. A HEART score of 0 in a patient with a TIMI of 0 identified a group of patients at less than 1% risk for 30-day adverse events.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalCritical Pathways in Cardiology
Volume12
Issue number1
DOIs
StatePublished - Mar 2013
Externally publishedYes

Fingerprint

Myocardial Infarction
Hospital Emergency Service
Acute Coronary Syndrome
Confidence Intervals
Myocardial Revascularization
Hospital Departments
Tertiary Healthcare
Tertiary Care Centers
Electrocardiography
Cohort Studies
History
Demography
Prospective Studies

Keywords

  • chest pain
  • emergency department
  • HEART risk score
  • risk stratification
  • TIMI risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

HEART score to further risk stratify patients with low TIMI scores. / Marcoon, Shannon; Chang, Anna Marie; Lee, Betsy; Salhi, Rama; Hollander, Judd E.

In: Critical Pathways in Cardiology, Vol. 12, No. 1, 03.2013, p. 1-5.

Research output: Contribution to journalArticle

Marcoon, Shannon ; Chang, Anna Marie ; Lee, Betsy ; Salhi, Rama ; Hollander, Judd E. / HEART score to further risk stratify patients with low TIMI scores. In: Critical Pathways in Cardiology. 2013 ; Vol. 12, No. 1. pp. 1-5.
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AB - Objective: The ability to risk stratify patients presenting to the emergency department (ED) with potential acute coronary syndrome (ACS) is critical. The thrombolysis in myocardial infarction (TIMI) risk score can risk stratify ED patients with potential ACS but cannot identify patients safe for ED discharge. The symptom-based HEART score identifies very low-risk patients. Our hypothesis was that patients with a TIMI score of 0 or 1 may be stratified further with the HEART score to identify a group of patients at less than 1% risk of 30-day cardiovascular events. Methods: We conducted a secondary analysis of a prospective cohort study in a tertiary care hospital ED. Patients with potential ACS who were >30 years of age were included. Data collected included demographics, history, electrocardiogram, laboratories, and components of the TIMI and HEART scores. Follow-up was conducted by structured record review and phone. The main outcome was a composite of death, acute myocardial infarction, or revascularization at 30 days. Results: There were 8815 patients enrolled (mean age, 52.8 ± 15.1 years; 57% women, and 69% black). At 30 days, the composite event rate was 8.0% (660 patients): 108 deaths, 410 acute myocardial infarction, and 301 revascularizations. Of the 485 patients with both a TIMI score of 0 and a HEART score of 0, there were no cardiovascular events (95% confidence interval, 0-0.8%); but no other score combination had an upper limit confidence interval less than 1%. Conclusion: At all levels of TIMI score, the HEART score was able to further substratify patients with respect to 30-day risk. A HEART score of 0 in a patient with a TIMI of 0 identified a group of patients at less than 1% risk for 30-day adverse events.

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