Add-on tests for improving risk-stratification in emergency department patients with chest pain who are at low to moderate risk of 30-day major adverse cardiac events

Rainer, Timothy; Leung, Yuk-ki; Lee, Anna; Chan, Pui Ying; Cheng, Nga-man; Wong, Jonathan; Yan, B.; Ahuja, Anil T.; Graham, Colin A.

doi:10.1016/j.ijcard.2016.05.057

Cited by 7 publications

(7 citation statements)

References 29 publications

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“…Our search identified 778 citations (Figure ) and following removal of duplicates, we screened 557 studies, from which 62 studies underwent full‐text review. We included 29 distinct cohorts from 30 studies in the meta‐analysis . All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies evaluated the prognostic accuracy of the HEART score using a low‐risk threshold (score between 0 and 3). Twenty‐one studies also evaluated the prognostic accuracy of the HEART score using a high‐risk threshold (score between 7 and 10) . Eight studies additionally evaluated the prognostic accuracy of a low‐risk TIMI (score of either 0 or 1) for prediction of MACE, while three evaluated the prognostic accuracy of a high‐risk TIMI (score of either 6 or 7) …”

Section: Resultsmentioning

confidence: 99%

“…There were 17 (56.7%) retrospective cohorts, 11 (36.7%) prospective cohorts, and two (6.7%) randomized trials. Sixteen studies evaluated the HEART score for 30‐day incidence of MACE, while 13 evaluated the HEART score for 6‐week incidence of MACE . Most studies included only patients presenting with chest pain, while five studies included patients presenting with “suspected ACS.” In 14 studies, the ECG was interpreted by an ED physician, while in seven studies the ECG was specifically interpreted by a cardiologist .…”

Section: Resultsmentioning

confidence: 99%

“…Most studies included only patients presenting with chest pain, while five studies included patients presenting with “suspected ACS.” In 14 studies, the ECG was interpreted by an ED physician, while in seven studies the ECG was specifically interpreted by a cardiologist . Four studies computed the HEART score using high‐sensitivity troponin assays, while the remaining studies used conventional troponin T or I assays (as used in the original study) …”

Section: Resultsmentioning

confidence: 99%

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Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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Objective: The HEART score has been proposed for emergency department (ED) prediction of major adverse cardiac events (MACE). We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult ED patients presenting with chest pain.Methods: We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception through May 2018 and included studies using the HEART score for the prediction of short-term MACE in adult patients presenting to the ED with chest pain. The main outcome was short-term (i.e., 30-day or 6-week) incidence of MACE. We secondarily evaluated the prognostic accuracy of the HEART score for prediction of mortality and myocardial infarction (MI). Where available, accuracy of the Thrombolysis in Myocardial Infarction (TIMI) score was determined. Results:We included 30 studies (n = 44,202) in analysis. A HEART score above the low-risk threshold (≥4) had a sensitivity of 95.9% (95% confidence interval [CI] = 93.3%-97.5%) and specificity of 44.6% (95% CI = 38.8%-50.5%) for MACE. A high-risk HEART score (≥7) had a sensitivity of 39.5% (95% CI = 31.6%-48.1%) and specificity of 95.0% (95% CI = 92.6%-96.6%) for MACE, whereas a TIMI score above the low-risk threshold (≥2) had a sensitivity of 87.8% (95% CI = 80.2%-92.8%) and specificity of 48.1% (95% CI = 38.9%-57.5%) for MACE. A high-risk TIMI score (≥6) was 2.8% sensitive (95% CI = 0.8%-9.6%), but 99.6% (95% CI = 98.5%-99.9%) specific for MACE. A HEART score ≥ 4 had a sensitivity of 95.0% (95% CI = 87.2%-98.2%) for prediction of mortality and 97.5% (95% CI = 93.7%-99.0%) for prediction of MI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…We also examined the c-statistics of various combination of TIMI and HEART score and their components and found that TIMI and HEART scores together achieved higher c-statistics than the individual tests alone. [26] Whether this potential benefit is worthwhile is debatable as the staff time saved by early discharge of these patients must be weighed up against the fact that all patients will require a system for accurate TIMI and/or HEART assessment at triage.…”

Section: Discussionmentioning

confidence: 99%

Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study

Leung

Cheng

Chan

et al. 2017

The Journal of Emergency Medicine

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Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

Nestler¹,

Sudhir²,

Brown³

et al. 2018

Annals of Emergency Medicine

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Add-on tests for improving risk-stratification in emergency department patients with chest pain who are at low to moderate risk of 30-day major adverse cardiac events

Cited by 7 publications

References 29 publications

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Early Exclusion of Major Adverse Cardiac Events in Emergency Department Chest Pain Patients: A Prospective Observational Study

Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

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