Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department. (February 2017)

• Record Type: Journal Article
• Authors: McCord, James; Cabrera, Rafael; Lindahl, Bertil; Giannitsis, Evangelos; Evans, Kaleigh; Nowak, Richard; Frisoli, Tiberio; Body, Richard; Christ, Michael; deFilippi, Christopher R.; Christenson, Robert H.; Jacobsen, Gordon; Alquezar, Aitor; Panteghini, Mauro; Melki, Dina; Plebani, Mario; Verschuren, Franck; French, John; Bendig, Garnet; Weiser, Silvia; Mueller, Christian; Twerenbold, Raphael; Katus, Hugo A.; Popp, Steffen; Ordóñez-Llanos, Jorge; Santalo-Bel, Miquel; Horner, Daniel; Dolci, Alberto; Jernberg, Tomas; Zaninotto, Martina; Manara, Alessandro; Dinkel, Carina; Menassanch-Volker, Sylvie; Jarausch, Jochen; Zaugg, Christian;
• Is Part Of: Circulation. Volume 10:Number 2(2017)
• Publication Date: 2017-02
• Subjects: mortality -- myocardial i -- nfarction -- patient discharge -- prognosis -- troponin-T; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Research -- Periodicals; Outcome assessment (Medical care) -- Periodicals; Evidence-based medicine -- Periodicals; 616.1007
• DOI: 10.1161/CIRCOUTCOMES.116.003101
• Languages: English
• ISSNs: 1941-7713

Abstract

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.