Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department

Tan, Jack Wei Chieh; Tan, Hong Qi; Sahlén, Anders; Yeo, Khung Keong; Chin, Woon Loong Calvin; Gao, Fei; Ong, Eng Hock Marcus; Yeo, Chin Pin; Ng, William; Lim, Swee Han

doi:10.1016/j.ajem.2019.158420

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…Patients in this group could be discharged safely from Emergency Department [24]. In the intermediate risk group, the MACE rate was 5.2%, which is lower than that found in previous studies [7,17,18]. A MACE rate of 5.2% is still unacceptably high to consider a discharge and patients in this group should likely still be admitted for clinical observation and further evaluation.…”

Section: Discussionmentioning

confidence: 56%

“…In line with previous published literature, we classified our patients into low, intermediate, and high risk groups according to the MACE rate to explore the potential usefulness of the score in our patient population. There appears to be variation in the boundaries for low, intermediate, and high risk patients [16,[18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…One of the criticisms of the validation study of the original HEART score by Backus BE et al [17]is that each emergency department used different cut off values for the troponin. However, none of the emergencies departments were reported to have used highly sensitive troponins apart from one recent publication assessing the use of highly sensitive troponin in the modified HEART score [18]. We aim to retrospectively analyze patients that come into our emergency department with chest pain and calculate the modified HEART score.…”

Section: Introductionmentioning

confidence: 99%

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Performance of The Modified Heart Score In An Asian Population

Sajeed

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Jun

et al. 2020

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INTRODUCTION Chest pain is the most common potentially life threatening presentation to the emergency department (ED). Furthermore, the identification of acute coronary syndrome (ACS) including its risk stratification and subsequent disposition can be challenging. The original HEART score was derived as a predictive tool to risk stratify patients presenting with undifferentiated chest pain (CP) and aid physician decision-making. However, it utilized conventional Troponins as its cardiac biomarker component. Our study aims to assess the utility of the modified HEART score with highly sensitive troponins in an Asian setting with mixed ethnicity to determine if it corroborates the findings of the another recent Chinese study by Chun-Peng MA et al[7]. METHODS Clinical data from 413 patients presenting to the ED for evaluation of chest pain were analyzed. The predictive value of the modified HEART score for determining MACE was then evaluated. RESULTS 49 patients (11.9%) had a MACE: 31 patients (7.5%) underwent PCI, and 1 patient (0.2%) underwent CABG. There were 17 (4.1%) deaths. Three risk groups were elucidated based on MACE. In the low risk group (0-2), there were 72 patients (17.4%), with a MACE rate of 1.4%. In the intermediate risk group (3-5), there were 233 patients (56.4%), with a MACE rate of 5.2%. In the high risk group (6-10), there were 108 patients (26.2%), with a MACE rate of 33.3%. CONCLUSION The modified HEART score is an effective risk stratification tool in an ethnically diverse Asian population. Furthermore, it identifies low risk patients who are candidates for early discharge from a local emergency department.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of The Modified Heart Score In An Asian Population

Sajeed

Dios

Jun

et al. 2020

Preprint

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“…population. There appears to be variation in the boundaries for low, intermediate, and high risk patients [16,[18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…One of the criticisms of the validation study of the original HEART score by Backus BE et al [17]is that each emergency department used different cut off values for the troponin. However, none of the emergencies departments were reported to have used highly sensitive troponins apart from one recent publication assessing the use of highly sensitive troponin in the modi ed HEART score [18]. We aim to retrospectively analyze patients that come into our emergency department with chest pain and calculate the modi ed HEART score.…”

Section: Introductionmentioning

confidence: 99%

Performance Of The Modified Heart Score In An Asian Population

Sajeed

Dios

Jun

et al. 2020

Preprint

View full text Add to dashboard Cite

INTRODUCTION Chest pain is the most common potentially life threatening presentation to the emergency department (ED). Furthermore, the identification of acute coronary syndrome (ACS) including its risk stratification and subsequent disposition can be challenging. The original HEART score was derived as a predictive tool to risk stratify patients presenting with undifferentiated chest pain (CP) and aid physician decision-making. However, it utilized conventional Troponins as its cardiac biomarker component. Our study aims to assess the utility of the modified HEART score with highly sensitive troponins in an Asian setting with mixed ethnicity to determine if it corroborates the findings of the another recent Chinese study by Chun-Peng MA et al[7]. METHODS Clinical data from 413 patients presenting to the ED for evaluation of chest pain were analyzed. The predictive value of the modified HEART score for determining MACE was then evaluated.RESULTS 49 patients (11.9%) had a MACE: 31 patients (7.5%) underwent PCI, and 1 patient (0.2%) underwent CABG. There were 17 (4.1%) deaths.Three risk groups were elucidated based on MACE. In the low risk group (0-2), there were 72 patients (17.4%), with a MACE rate of 1.4%. In the intermediate risk group (3-5), there were 233 patients (56.4%), with a MACE rate of 5.2%. In the high risk group (6-10), there were 108 patients (26.2%), with a MACE rate of 33.3%. CONCLUSION The modified HEART score is an effective risk stratification tool in an ethnically diverse Asian population. Furthermore, it identifies low risk patients who are candidates for early discharge from a local emergency department.

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Single vs Serial Measurements of Cardiac Troponin Level in the Evaluation of Patients in the Emergency Department With Suspected Acute Myocardial Infarction

et al. 2021

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IMPORTANCE Chest pain is among the most common reasons for emergency department (ED) presentations. However, most patients are at low risk for acute coronary syndrome (ACS), with low cardiac adverse outcomes rates. Biomarker testing with troponin levels is key in the initial assessment for ACS. Although serial troponin testing can improve the diagnosis of ACS in clinical practice, some patients deemed to be low risk are discharged after a single negative troponin test result.OBJECTIVE To report the clinical outcomes of patients discharged after a single negative troponin test result compared with patients discharged after serial troponin measurements. DESIGN, SETTING, AND PARTICIPANTSThis is a retrospective cohort study of ED encounters from May 5, 2016, to December 1, 2017, across 15 community EDs within an integrated health care system in southern California. The study cohort includes 27 918 adult ED encounters in which patients were evaluated for suspected ACS with a HEART (history, electrocardiogram, age, risk factors, and troponin) score and an initial conventional troponin-I measurement below the level of detection (<0.02 ng/mL). Statistical analysis was performed from December 1, 2019, to December 1, 2020. EXPOSURE Single troponin test vs multiple troponin tests. MAIN OUTCOMES AND MEASURES The primary outcome was acute myocardial infarction or cardiac mortality; secondary outcomes included coronary artery bypass graft, percutaneous coronary intervention, invasive coronary angiography, and unstable angina within 30 days of discharge. A multivariable logistic regression model was performed to evaluate the association between testing strategies and clinical outcomes. RESULTS A total of 27 918 patient encounters (16 212 women [58.1%]; mean [SD] age, 58.7 [15.2] years) were included in the study. Of patients with an initial troponin measurement below the level of detection, 14 459 (51.8%) were discharged after a single troponin measurement, and 13 459 (48.2%) underwent serial troponin tests. After adjustment for cardiac risk factors and comorbidities, there was no statistically significant difference in the primary outcome of acute myocardial infarction or cardiac mortality within 30 days between the 2 groups (single troponin, 56 [0.4%] vs serial troponin, 52 [0.4%]; adjusted odds ratio, 1.41 [95% CI, 0.96-2.07]). Patients discharged after a single troponin test had lower rates of coronary artery bypass graft (adjusted odds ratio, 0.24 [95% CI, 0.11-0.48]) and invasive coronary angiography (adjusted odds ratio, 0.46 [95% CI, 0.38-0.56]). (continued) Key Points Question Do patients discharged from the emergency department after a single troponin test with negative results have similar outcomes to patients undergoing multiple troponin tests? Findings This cohort study found no significant difference in 30-day acute myocardial infarction or cardiac mortality between patients receiving a single troponin test with negative results and those who underwent serial troponin tests (single troponin test, 0.4% vs serial tr...

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Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department

Cited by 12 publications

References 17 publications

Performance of The Modified Heart Score In An Asian Population

Performance of The Modified Heart Score In An Asian Population

Performance Of The Modified Heart Score In An Asian Population

Single vs Serial Measurements of Cardiac Troponin Level in the Evaluation of Patients in the Emergency Department With Suspected Acute Myocardial Infarction

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