HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department

Arslan, Murat; Schaap, Jeroen; Rood, Pleunie P.M.; Nieman, Koen; Budde, Ricardo P.J.; Allaoui, Mohamed; Dubois, Éric; Dedic, Admir

doi:10.1177/2048872619882424

Cited by 6 publications

(6 citation statements)

References 28 publications

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“…In recent years, with the changes of social environment and living habits, the incidence of coronary heart disease is also getting higher and higher. It has been called one of the main causes of human death in cardiovascular diseases, which poses a serious threat to human life and health (1,2). The gold standard for the diagnosis of coronary heart disease has been coronary angiography, which has high sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

lncRNA‑MALAT1 expression in patients with coronary atherosclerosis and its predictive value for in‑stent restenosis

Qiu

Sun

2020

Exp Ther Med

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This study was designed to investigate the long non-coding RNA (lncRNA)-metastasis associated lung adenocarcinoma transcript 1 (MALAT1) expression in patients with coronary atherosclerosis and its predictive value for in-stent restenosis. Ninety-five patients with coronary heart disease who came to our hospital for treatment and underwent stent implantation were selected as a research group (RG), and 95 volunteers undergoing physical examination who did not suffer from coronary heart disease during the same period were selected as a control group (CG). MALAT1 of subjects in both groups before and after treatment were detected by RT-qPCR, and N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hs-CRP), lactate dehydrogenase (LDH), and creatine kinase isoenzyme (CK-MB) of them in the RG before treatment were detected. The level was evaluated and detected, and its correlation with MALAT1 was analyzed. Then, the predictive value of MALAT1 for in-stent restenosis in patients with coronary heart disease was analyzed. MALAT1 expression in patients with coronary heart disease was higher than that of normal subjects (P<0.05); after treatment, the expression levels of MALAT1, NT-proBNP, hs-CRP, LDH, and CK-MB in the serum of patients were significantly lower than those before treatment (P<0.05); MALAT1 expression was positively correlated with the expression levels of NT-proBNP, hs-CRP, LDH, and CK-MB (P<0.05). Receiver operating characteristic of MALAT1 for predicting in-stent restenosis in patients with coronary heart disease was over 0.8; the number of lesions, MALAT1, diabetes, NT-proBNP and hs-CRP were independent risk factors for in-stent restenosis. MALAT1 is highly expressed in the serum of patients with coronary heart disease, and it has high value in its diagnosis and the prediction of in-stent restenosis. It is also an independent risk factor for in-stent restenosis in patients with coronary heart disease.

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Section: Introductionmentioning

confidence: 99%

lncRNA‑MALAT1 expression in patients with coronary atherosclerosis and its predictive value for in‑stent restenosis

Qiu

Sun

2020

Exp Ther Med

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“…For instance, Arslan et al reclassified 74.1% of patients with intermediate HEART scores as low risk using CCTA. 20 Shin et al similarly reclassified 68.7% as low risk, 28.7% more than the HEART Pathway alone. 21 Our collective findings are important given that that only 36% of US hospitals staff dedicated observation units according to the latest National Hospital Ambulatory Medical Care Survey.…”

Section: Discussionmentioning

confidence: 99%

“…Also, those studies assessed HEART scores only in patients who underwent CCTA, excluding a significant proportion of low-risk patients. 20,21 Our study included all low-risk patients, which more closely aligns with real-world scenarios in which ED providers will use the HEAR score to determine whether CCTA is appropriate.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Impact of the Combined Application of Coronary CT Angiography With the HEART Pathway in Patients With Suspected Acute Coronary Syndrome

Matuskowitz

Obeid

Jennings

et al. 2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: This study examines the feasibility and utility of integrating coronary computed tomography angiography and the HEART Pathway into a novel accelerated diagnostic protocol-called HEART-CT-and assesses its impact as an optional interactive decision support tool (smart form) in the electronic health record. Methods: This was a retrospective observational study performed in 2 adult emergency departments (ED) among patients evaluated for suspected acute coronary syndrome. Primary outcomes included the rate of discharge from the ED following HEART-CT Smart Form use, 30-day major adverse cardiac events (MACE), and ED length of stay (LOS). Hypothesis-generating outcomes included the rate of Smart Form use by ED providers and whether adhering to the HEART-CT recommendations was associated with improved outcomes. Results:The study included 672 subjects, 78.1% of whom were discharged from the ED. HEART-CT identified 76.7% of patients with increased risk HEAR scores as safe for discharge. No patients identified as low risk by HEART-CT had MACE within 30 days. Total mean ED LOS was 4.6 hours. ED providers used the HEART-CT smart form in 19.7% of eligible patients. ED providers who followed the HEART-CT recommendations had 3.41 times higher odds of ED discharging patients with increased risk HEAR scores than nonadherent providers (95% CI, 2.20-5.27). Conclusions: HEART-CT reclassified a large proportion of patients as safe for discharge, maintained a high sensitivity for detecting 30-day MACE, and had an acceptable ED LOS. Future studies should test the extent to which more automated clinical decision support improves provider adoption and clinical outcomes of HEART-CT.

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“…11,12 The HEART score (HS) is designed for acute risk stratification of CP in the emergency setting to identify low-risk patients eligible for discharge without further testing and has been validated for safety and efficacy. 13 Arslan et al 14 performed a secondary analysis of ED patients with ACS symptoms undergoing CCTA and found that combining HS with CCTA significantly and safely reduced the need for CCTA.…”

Section: Importancementioning

confidence: 99%

Impact of HEART Score Decision Aid on Coronary Computed Tomography Angiography Utilization and Diagnostic Yield in the Emergency Department

McMahon

Shrestha

Thode

et al. 2023

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Objective: Emergency physicians are challenged to efficiently and reliably risk stratify patients presenting with chest pain (CP) to optimize diagnostic testing and avoid unnecessary hospital admissions. The objective of our study was to evaluate the impact of a HEART score-based decision aid (HSDA) integrated in the electronic health record on coronary computed tomography angiography (CCTA) utilization and diagnostic yield in adult emergency department (ED) CP patients with suspected acute coronary syndrome. Methods: We conducted a before and after study to determine whether implementation of a mandatory computerized HSDA would reduce CCTA utilization in ED CP patients and improve the diagnostic yield of obstructive coronary artery disease (CAD) (≥50%). We included all adult ED CP patients with suspected acute coronary syndrome during the first 6 months of 2018 (before) and 2020 (after) at a large academic center. CCTA utilization and obstructive CAD yield were compared in patients before and after implementing the HSDA using χ 2 tests. Secondarily, we assessed the association of HEART scores and CCTA results. Results: Of the 3095 CP patients during the before study period, 733 underwent CCTA. Of the 2692 CP patients during the after study period, 339 underwent CCTA. CCTA utilization before and after HSDA was 23.4% [95% confidence interval (95% CI), 22.2-25.2] and 12.6% (95% CI, 11.4-13.0), respectively; mean difference was 11.1% (95% CI, 0.9-13.0). Among 1072 patients undergoing CCTA, mean (SD) age and percent females before versus after HSDA were 54 (11) versus 56 (11) years and 50% versus 49%, respectively. We included 1014 patients (686 before and 328 after) for the yield analysis. Obstructive CAD was present in 15% (95% CI, 12.7-17.9) and 20.1% (95% CI, 16.1-24.7) before and after HSDA, respectively; mean difference was 4.9% (95% CI, 0.1-10.1). Conclusions: Implementation of a mandatory electronic health record HSDA aid reduced ED CCTA utilization by half and improved the diagnostic yield.

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HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department

Cited by 6 publications

References 28 publications

lncRNA‑MALAT1 expression in patients with coronary atherosclerosis and its predictive value for in‑stent restenosis

lncRNA‑MALAT1 expression in patients with coronary atherosclerosis and its predictive value for in‑stent restenosis

Feasibility and Impact of the Combined Application of Coronary CT Angiography With the HEART Pathway in Patients With Suspected Acute Coronary Syndrome

Impact of HEART Score Decision Aid on Coronary Computed Tomography Angiography Utilization and Diagnostic Yield in the Emergency Department

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