HEART Score in Predicting One-Month Major Adverse Cardiac Events in Patients with Acute Chest Pain; a Diagnostic Accuracy Study:

Introduction: Screening of high-risk patients and accelerating their therapeutic procedures can reduce the burden of acute coronary syndrome (ACS). This study aimed to evaluate the accuracy of HEART score in predicting the risk of one-month major adverse cardiac events (MACE) in these patients. Methods: In this prospective cross-sectional study, the accuracy of HEART score in patients over 18 years old who presented to emergency department following acute chest pain, was evaluated during a 21-month period. Each patient was followed up regarding the incidence of MACE for one month via phone call and the hospital’s integrated health information system. Results: 240 cases with the mean age of 60.50 ± 16.07 years were studied (56.3% male).  MACE was observed in 77 (32.1%) cases. The most common MACE was percutaneous coronary artery revascularization (PCAR) (12.9%). The mean HEART score of studied cases was 4.74 ± 2.12. The mean score of cases with MACE was significantly higher than others (6.25 ± 1.97 versus 4.03 ± 1.79; p < 0.0001).  Based on this score, the risk of MACE was high in 34 (14.2%), moderate in 118 (49.2%), and low in 88 (36.7%) cases. The incidence of one-month MACE was 85.3% in high-risk cases, 35.6% in moderate one, and 6.8% in low-risk cases based on HEART score. The area under the ROC curve of HEART score in predicting the risk of MACE was 0.796 (95% CI: 0.736 – 0.856). The best cut off point of HEART score in this regard was calculated as 4.5. The sensitivity and specificity of this score in 4.5 cut off were 83.11% (95% CI: 72.49 – 90.35) and 66.25% (95% CI: 58.38 – 73.35), respectively. Conclusion: Based on the findings of the present study the mean HEART score of ACS patients with one-month MACE was significantly higher than others and the incidence of MACE in high-risk patients was significantly higher. But the overall accuracy of score in predicting one-month MACE in ACS patients was in moderate range.