Performance of The Modified Heart Score In An Asian Population

Abstract

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.

A Closer Look at the HEART Score

“…To improve upon the discriminatory power of the original HEART score or to circumvent some of its limitations, a number of variants of the HEART score have been reported over the years. Table 2 [7,10,[14][15][16][17][18][19][20] summarizes the variants described here; HEAR score, modified HEART score, HEART pathway, HEART-2 score, and HEARTS 3 score.…”

“…Most variants described usually involve interpreting various cardiac troponin assay protocols. The term "modified HEART score" usually refers to these variants [7,15,16,[22][23][24]. The term has been proposed when a high-sensitivity cardiac troponin (hs-cTn) assay is used in calculating the score in place of conventional troponin by some investigators.…”

“…Over the years, the performance of troponin assays has substantially improved. Compared to the troponin assay used in the original study reported by Six et al [1], the fifth-generation ultra-high sensitivity troponin assay currently used is up to 100-fold more sensitive [15]. With an advancement in cTn assay technology, more recent studies usually utilized high-sensitivity cardiac troponin-T assay (hs-cTnT) and hs-cTnI assay to help improve discriminatory power of the HEART score.…”