All patients underwent central laboratory testing over 3–12 hours.
Furthermore, using the first 4 items (i.e.
not considering troponin), a modified “HEAR” score ≤1, should exclude ACS without requiring any biomarker testing. None of the 512 (37.2 %) patients with a low HEART score had an event within 180 days. We retrospectively analyzed the HEART score of 1597 consecutive patients admitted to the Emergency Department of our Hospital for chest pain between January 1 and June 30, 2014. Moreover, the accuracy of diagnosing myocardial injury more than merely increases with hs-troponin; the Fourth Universal Definition of Myocardial Infarction is met specifically by the presence of a value above the 99th percentile and a rise or fall in that value (in order to be considered acute). Session Moderated Cases 2: Chest pain, arrhythmias and more . The HEART Score was calculated as published using the LoD, 99th percentile and functional sensitivity as the upper limit of normal for troponin. In summary, a low-risk HEART score coupled with two negative cardiac troponin tests drawn three to six hours apart has a negative predictive value of 30-day MACE that approaches 100%.3 In the HEART Pathway arm, ED providers used a clinical decision aid, the HEART (History ECG Age Risk factors Troponin) score, paired with serial cTn measures at 0 and 3 h to guide disposition decisions. The HEART score was described in the Netherlands in 2008 and retrospectively validated initially in a European Cohort, then in the United States at Wake Forest University where they retrospectively found the rates of MACE (Major Adverse Cardiac Events) ** at 6 weeks in patients with HEART scores of 0-3 to be 0.6% (5/904 pts). One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. HEART score assigns 0 to 2 points to 5 items: History, ECG, Age, Risk factors, Troponin. A HEART score of 0–2 was taken as low risk (BEST-HEART score). Crossref | PubMed Mokhtari A, Borna C, Gilje P, et al.
Score ≤3 could rule out ACS with a single troponin assay at ED admission. Of these, 190 did not meet the inclusion criteria and 29 were lost to follow-up. Low risk chest pain pathway incorporating modified heart score and high sensitivity troponin reduces patient length of stay and hospital admissions whilst promoting safety with targeted follow up. Speaker Agnieszka Kopanska
Am Heart J 2016;171:92–102.e1–5.