Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients

Abstract

In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0-1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0-0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

Identifying Patients with Low Risk of Acute Coronary Syndrome Without Troponin Testing: Validation of the HEAR Score

“…The predefined threshold is set to 2, defining a low HEAR score (score 0 or 1) or a high HEAR score (score from 2 to 8). 9 A low HEAR score was previously determined based on its ability to rule out the…”

“…8 Some of us recently reported on the HEAR score (History, Electrocardiogram, Age, and Risk factors), which is identical to the HEART score (History, Electrocardiogram, Age, and Risk factors, Troponin), without the troponin test. 9 HEAR score successfully identified patients at low risk of a major adverse cardiac event. This tool would be especially useful in the primary care setting, or any settings where throughput is an issue.…”

The performance of HEAR score for identification of low-risk chest pain: a systematic review and meta-analysis

“…We tried to communicate with the corresponding authors of the abstracts via email for their published studies in full text, but received only studies that were already included. Therefore, 10 studies were finally included and considered eligible for systematic review and analysis [9,10,33–40] (Supplementary Figure 1, Supplemental digital content 2, http://links.lww.com/EJEM/A332 ).…”

“…In this systematic review, 33 843 patients were included from 10 studies [9,10,33–40]. Five studies were conducted in Europe [9,33,34,38,40], one in Asia [37], and the rest in North America [10,35,36,39]. Seven studies were conducted in the EDs [9,10,34–38] and three studies were in the prehospital [33,39,40].…”

Complicated myocardial infarction in a 99-year-old lady in the era of COVID-19 pandemic: from the need to rule out coronavirus infection to emergency percutaneous coronary angioplasty

“…Finally, the diagnosis and management of patients with chest pain admitted to emergency departments has always been a very challenging task [5,[12][13][14], but it is clear that the COVID-19 pandemic makes the process of triage and appropriate decision making even more demanding [2,4,15].…”