Key result
HEART score outperforms TIMI and EDACS for 30-day MACE prediction with ~97% NPV.
Why the study?
The comparative performance of EDACS, HEART, TIMI, and EDACS-ADP scores in identifying low-risk ACS patients and predicting 30-day MACE was unclear.
Does the HEART score perform better than TIMI, EDACS, and EDACS-ADP scores in predicting 30-day MACE in adult patients presenting to the emergency department with nontraumatic chest pain?
Cohort (n=408)
No
Does the HEART score perform better than TIMI, EDACS, and EDACS-ADP scores in predicting 30-day MACE in adult patients presenting to the emergency department with nontraumatic chest pain?
Effect estimate: AUC 0.823 (95% CI 0.775-0.871)
Absolute Event Rate: 0.823% vs 0.784%
p-value: p=<0.001
The HEART score demonstrated superior diagnostic performance compared to TIMI and EDACS scores for identifying low-risk patients and predicting 30-day MACE in emergency department patients with chest pain.
May support HEART preference for ED chest pain stratification; extends validation but leaves open prospective outcome trials.
Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score (EDACS), History, Electrocardiography, Age, Risk Factors, Troponin (HEART), and Thrombolysis in Myocardial Infarction (TIMI) in identifying low-risk acute coronary syndrome (ACS) patients and predicting 30-day major adverse cardiac events (MACE). Materials and Methods: This prospective study included patients aged ≥18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve (AUC) analysis. Results: Among 408 patients, 64 (15.7%) developed MACE. The HEART score had the highest AUC (0.823), followed by TIMI (0.784), EDACS-ADP (0.769), and EDACS (0.716). HEART had the highest sensitivity (90.6%) and negative predictive value (NPV; 97.2%). TIMI, at a ≤1 cut-off, had sensitivity of 81.3% and NPV of 94.7%; reducing the cut-off to
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Sarıbaş et al. (2024) conducted a cohort in Acute coronary syndrome (n=408). HEART score vs. TIMI, EDACS, and EDACS-ADP scores was evaluated on Prediction of 30-day major adverse cardiac events (MACE) (AUC 0.823, 95% CI 0.775-0.871, p=<0.001). The HEART score outperformed TIMI, EDACS, and EDACS-ADP in predicting 30-day major adverse cardiac events with an AUC of 0.823 and a negative predictive value of 97.2%.
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