Key result
Neither the HEAR score nor HE-MACS achieved sufficient negative or positive predictive value to rule out or rule in 30-day MACE in prehospital chest pain patients.
Why the study?
To determine if the troponin-free HEAR or HE-MACS risk scores could achieve a negative predictive value of 99% or higher to rule out 30-day MACE, or a positive predictive value of 50% or higher to rule in patients needing interventional cardiology.
Do the HEAR or HE-MACS scores achieve sufficient predictive value for 30-day MACE in prehospital chest pain patients?
Cohort (n=767)
Do the HEAR or HE-MACS scores achieve sufficient predictive value for 30-day MACE in prehospital chest pain patients?
p-value: p=0.41
Prehospital use of HEAR and HE-MACS scores without troponin is insufficient to safely rule out or rule in 30-day MACE in patients with acute chest pain.
HEAR and HE-MACS lack adequate prehospital predictive value for 30-day MACE; leaves open whether troponin integration improves performance in prospective studies.
OBJECTIVE: The History, Electrocardiogram (ECG), Age, and Risk factor (HEAR) and History and ECG-only Manchester Acute Coronary Syndromes (HE-MACS) risk scores can risk stratify chest pain patients without troponin measures. The objective of this study was to determine if either risk score could achieve the ≥99% negative predictive value (NPV) required to rule out major adverse cardiovascular events (MACE; a composite of all-cause death, myocardial infarction, or coronary revascularization) at 30 days or the ≥50% positive predictive value (PPV) indicative of a patient possibly needing interventional cardiology. METHODS: = 767, 4/2018-1/2019) trials, which accrued adults ≥21 years old with acute non-traumatic chest pain transported by emergency medical services (EMS). Paramedics prospectively completed risk assessment forms. Very low risk was defined by a HEAR score of 0-1 or HE-MACS probability <4%. The primary outcome was 30-day MACE, which was determined by adjudication (PARAHEART) or electronic record review (RESCUE). NPV and PPV with exact 95% confidence intervals (95%CI) for 30-day MACE were calculated for each risk score and compared using McNemar's tests. RESULTS: = 0.41)]. CONCLUSIONS: In two prehospital chest pain cohorts, neither the HEAR score nor HE-MACS achieved sufficient NPV or PPV to rule out or rule in 30-day MACE.
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Popp et al. (2022) conducted a cohort in Acute non-traumatic chest pain (n=767). HEAR and HE-MACS risk scores was evaluated on 30-day MACE (composite of all-cause death, myocardial infarction, or coronary revascularization) (p=0.41). Neither the HEAR score nor HE-MACS achieved sufficient negative or positive predictive value to rule out or rule in 30-day MACE in prehospital chest pain patients.
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