Key result
The modified HEART score integrating fingerstick point-of-care high-sensitivity troponin I testing ruled out acute coronary syndrome in low-risk patients with a sensitivity of 97.0% and a negative predictive value of 97.6%.
Why the study?
Fingerstick point-of-care troponin testing enables rapid pre-hospital measurement, but the diagnostic accuracy of a modified HEART score integrating this technique to rule out ACS required investigation.
Does the modified HEART score integrating fingerstick POC hs-cTnI accurately rule out acute coronary syndrome in patients with chest pain?
Observational (n=96)
No
Does the modified HEART score integrating fingerstick POC hs-cTnI accurately rule out acute coronary syndrome in patients with chest pain?
Effect estimate: Sensitivity 97.0% (95% CI 84.2-99.9)
The modified HEART score using fingerstick point-of-care high-sensitivity troponin I demonstrates high sensitivity and negative predictive value for ruling out ACS in emergency department patients with chest pain.
Hypothesis-generating for point-of-care troponin in modified HEART score; leaves open need for validation before clinical adoption.
BACKGROUND: The HEART score is a validated risk stratification tool for chest pain patients presenting to the emergency department and was recently investigated for implementation in a pre-hospital setting. Fingerstick (capillary blood) point-of-care (POC) troponin testing enables quick measurements outside the hospital and seems easier to implement than the current venous blood sampling techniques. This study investigates the diagnostic accuracy of the modified HEART score, integrating fingerstick POC troponin testing, in ruling out acute coronary syndrome (ACS). METHODS: The data of 96 patients with chest pain, included in a study investigating a novel POC troponin device under development at the cardiac emergency department, were analysed retrospectively. Based on the patients' admission data and capillary POC high-sensitivity troponin I (hs-cTnI) results, the modified HEART score was determined. The outcome measure, for evaluating the diagnostic accuracy of the modified HEART score, was the occurrence of ACS. RESULTS: Of the total study population, 33 patients (34%) were diagnosed with ACS. Seventeen patients (18%) were classified as low risk (0-3 points) and one patient (6%) in this group was diagnosed with ACS. The sensitivity and negative predictive value of the modified HEART score was 97.0 and 97.6%, respectively. CONCLUSION: The modified HEART score, integrating capillary POC hs-cTnI results, is a promising tool for ruling out ACS in patients with chest pain presenting to the cardiac emergency department. These results encourage prospective investigation into the integration of fingerstick POC troponin testing in the modified HEART score in a pre-hospital setting.
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Koper et al. (2021) conducted an observational in Chest pain with suspected acute coronary syndrome (n=96). Modified HEART score with fingerstick point-of-care hs-cTnI testing vs. Reference standard (physician diagnosis of ACS) was evaluated on Sensitivity for ruling out acute coronary syndrome in low-risk patients (Sensitivity 97.0%, 95% CI 84.2-99.9). The modified HEART score integrating fingerstick point-of-care high-sensitivity troponin I testing ruled out acute coronary syndrome in low-risk patients with a sensitivity of 97.0% and a negative predictive value of 97.6%.
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