Assessing the Utility of the Heart Score in the Era of High-Sensitivity Troponin

There is uncertainty in the clinical utility of the HEART score, given its incorporation of an older generation of troponin assay. We sought to determine whether high-sensitivity troponin I (Hs-TnI) alone can effectively stratify cardiovascular risk in patients presenting to the emergency department (ED) with moderate or high HEART score by analyzing the management and outcomes of adults presenting to our ED with chest pain, moderate or high HEART score, and Hs-TnI below the 99th percentile. For this population, we calculated the negative predictive value (NPV) of Hs-TnI in ruling out a major adverse cardiac event (MACE; defined as myocardial infarction or death from a cardiovascular or unknown cause) at 30 days. The average HEART score was 5.1, and 1224 patients (92.0%) had a moderate HEART score (4-6) and 107 patients (8.0%) had a high HEART score (7+). The average age of patients was 59.0 years and 52.7% were women. The incidence of 30-day MACE was 0.2%. Overall, in this cohort of patients with moderate or high HEART score, Hs-TnI below the 99th percentile had an NPV of 99.8% (95% CI: 99.6% - 100.0%) in ruling out MACE at 30 days. Given the low event rate, a moderate or high HEART score should not be the sole determinant for admission when Hs-Tnl is not elevated.