TY - JOUR
T1 - HEART score to further risk stratify patients with low TIMI scores
AU - Marcoon, Shannon
AU - Chang, Anna Marie
AU - Lee, Betsy
AU - Salhi, Rama
AU - Hollander, Judd E.
PY - 2013/3/1
Y1 - 2013/3/1
N2 - 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.
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.
KW - HEART risk score
KW - TIMI risk score
KW - chest pain
KW - emergency department
KW - risk stratification
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U2 - 10.1097/HPC.0b013e31827377e1
DO - 10.1097/HPC.0b013e31827377e1
M3 - Article
C2 - 23411600
AN - SCOPUS:84874357644
VL - 12
SP - 1
EP - 5
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
SN - 1535-282X
IS - 1
ER -