Prognostic utility of a modified HEART score in chest pain patients in the emergency department

Circulation: Cardiovascular Quality and Outcomes

Volumn 10, Issue 2, 2017, Pages

  Mccord, James ^a   Cabrera, Rafael ^a   Lindahl, Bertil ^c   Giannitsis, Evangelos ^d   Evans, Kaleigh ^e   Nowak, Richard ^b   Frisoli, Tiberio ^a   Body, Richard ^f   Christ, Michael ^g   DeFilippi, Christopher R ^h   Christenson, Robert H ⁱ   Jacobsen, Gordon ^b   Alquezar, Aitor ^j   Panteghini, Mauro ^k   Melki, Dina ^l   Plebani, Mario ^m   Verschuren, Franck ⁿ   French, John ^o   Bendig, Garnet ^p   Weiser, Silvia ^p   Mueller, Christian ^q   more..

^a HENRY FORD HEART AND VASCULAR INSTITUTE   (United States)

^b HENRY FORD HEALTH SYSTEM   (United States)

^c UPPSALA UNIVERSITY   (Sweden)

^d UNIVERSITY HOSPITAL HEIDELBERG   (Germany)

^e HENRY FORD HOSPITAL   (United States)

^f MANCHESTER UNIVERSITY NHS FOUNDATION TRUST   (United Kingdom)

^g PARACELSUS MEDICAL UNIVERSITY   (Germany)

^h INOVA HEART AND VASCULAR INSTITUTE   (United States)

ⁱ UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE   (United States)

^j HOSPITAL DE LA SANTA CREU I SANT PAU   (Spain)

^k UNIVERSITY OF MILAN   (Italy)

^l KAROLINSKA UNIVERSITY HOSPITAL   (Sweden)

^m UNIVERSITY HOSPITAL OF PADOVA   (Italy)

ⁿ CLINIQUES UNIVERSITAIRES SAINT LUC   (Belgium)

^o UNIVERSITY OF NEW SOUTH WALES   (Australia)

^p ROCHE DIAGNOSTICS GMBH   (Germany)

^q UNIVERSITY HOSPITAL BASEL   (Switzerland)

more..

Author keywords

mortality; myocardial i; nfarction; patient discharge; prognosis; troponin T

Indexed keywords

ACETYLSALICYLIC ACID; TROPONIN; BIOLOGICAL MARKER; TROPONIN T;

ACUTE HEART INFARCTION; ADULT; AGED; ARTICLE; CARDIOVASCULAR DISEASE ASSESSMENT; CARDIOVASCULAR RISK; CLINICAL EVALUATION; CLINICAL PROTOCOL; CONTROLLED STUDY; EMERGENCY WARD; FEMALE; HEART DISEASE; HUMAN; LOW RISK PATIENT; MAJOR CLINICAL STUDY; MALE; MODIFIED HEART SCORE; MULTICENTER STUDY; OUTCOME ASSESSMENT; PRIORITY JOURNAL; PROGNOSIS; RISK ASSESSMENT; RISK FACTOR; THORAX PAIN; ALGORITHM; ANGINA PECTORIS; AUSTRALIA; BLOOD; CARDIOLOGY SERVICE; CLINICAL TRIAL; COMPLICATION; DIFFERENTIAL DIAGNOSIS; EUROPE; HOSPITAL DISCHARGE; HOSPITAL EMERGENCY SERVICE; MIDDLE AGED; MORTALITY; MYOCARDIAL INFARCTION; PREDICTIVE VALUE; PROSPECTIVE STUDY; TIME FACTOR; UNITED STATES; UPREGULATION;

ADULT; AGED; ALGORITHMS; ANGINA PECTORIS; AUSTRALIA; BIOMARKERS; CARDIOLOGY SERVICE, HOSPITAL; DIAGNOSIS, DIFFERENTIAL; EMERGENCY SERVICE, HOSPITAL; EUROPE; FEMALE; HUMANS; MALE; MIDDLE AGED; MYOCARDIAL INFARCTION; PATIENT DISCHARGE; PREDICTIVE VALUE OF TESTS; PROGNOSIS; PROSPECTIVE STUDIES; RISK ASSESSMENT; RISK FACTORS; TIME FACTORS; TROPONIN T; UNITED STATES; UP-REGULATION;

EID: 85014623424     PISSN: 19417713     EISSN: 19417705     Source Type: Journal    
DOI: 10.1161/CIRCOUTCOMES.116.003101     Document Type: Article

References (48)

1. Goodacre S, Cross E, Arnold J, Angelini K, Capewell S, Nicholl J, The health care burden of acute chest pain. Heart 2005 91 229 230. doi: 10.1136/hrt.2003.027599
2. Owens PL, Barrett ML, Gibson TB, Andrews RM, Weinick RM, Mutter RL, Emergency department care in the United States: a profile of national data sources. Ann Emerg Med 2010 56 150 165. doi: 10.1016/j.annemergmed.2009.11.022
3. Pollack CV Jr, Sites FD, Shofer FS, Sease KL, Hollander JE, Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med 2006 13 13 18. doi: 10.1197/j.aem.2005.06.031
4. Chase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE, Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population. Ann Emerg Med 2006 48 252 259. doi: 10.1016/j.annemergmed.2006.01.032
5. Hollander JE, The continuing search to identify the very-low-risk chest pain patient. Acad Emerg Med 1999 6 979 981
6. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP, Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000 342 1163 1170. doi: 10.1056/NEJM200004203421603
7. Nasis A, Meredith IT, Nerlekar N, Cameron JD, Antonis PR, Mottram PM, Leung MC, Troupis JM, Crossett M, Kambourakis AG, Braitberg G, Hoffmann U, Seneviratne SK, Acute chest pain investigation: utility of cardiac CT angiography in guiding troponin measurement. Radiology 2011 260 381 389. doi: 10.1148/radiol.11110013
8. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation 2012 125 e2 e220. doi: 10.1161/CIR.0b013e31823ac046
9. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ, ACC/AHA Task Force Memebers; Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons 2014 aha/acc guideline for the management of patients with non-st-elevation acute coronary syndromes: Executive summary: A report of the american college of cardiology/american heart association task force on practice guidelines. Circulation 2014 130 2354 2394. doi: 10.1161/CIR.0000000000000133
10. Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA, Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 2011 342 d2983
11. Diercks DB, Roe MT, Chen AY, Peacock WF, Kirk JD, Pollack CV Jr, Gibler WB, Smith SC Jr, Ohman M, Peterson ED, Prolonged emergency department stays of non-st-segment-elevation myocardial infarction patients are associated with worse adherence to the american college of cardiology/american heart association guidelines for management and increased adverse events. Ann Emerg Med 2007 50 489 496
12. Six AJ, Backus BE, Kelder JC, Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008 16 191 196
13. Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA, A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013 168 2153 2158. doi: 10.1016/j.ijcard.2013.01.255
14. Mahler SA, Hiestand BC, Goff DC Jr, Hoekstra JW, Miller CD, Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events? Crit Pathw Cardiol 2011 10 128 133. doi: 10.1097/HPC.0b013e3182315a85
15. Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, Doevendans PA, Than M, The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol 2013 12 121 126. doi: 10.1097/HPC.0b013e31828b327e
16. Melki D, Jernberg T, HEART score: a simple and useful tool that may lower the proportion of chest pain patients who are admitted. Crit Pathw Cardiol 2013 12 127 131. doi: 10.1097/HPC.0b013e3182953359
17. Reichlin T, Twerenbold R, Reiter M, Steuer S, Bassetti S, Balmelli C, Winkler K, Kurz S, Stelzig C, Freese M, Drexler B, Haaf P, Zellweger C, Osswald S, Mueller C, Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis. Am J Med 2012 125 1205 1213.e1. doi: 10.1016/j.amjmed.2012.07.015
18. Bonaca M, Scirica B, Sabatine M, Dalby A, Spinar J, Murphy SA, Jarolim P, Braunwald E, Morrow DA, Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. J Am Coll Cardiol 2010 55 2118 2124. doi: 10.1016/j.jacc.2010.01.044
19. Reichlin T, Schindler C, Drexler B, Twerenbold R, Reiter M, Zellweger C, Moehring B, Ziller R, Hoeller R, Rubini Gimenez M, Haaf P, Potocki M, Wildi K, Balmelli C, Freese M, Stelzig C, Freidank H, Osswald S, Mueller C, One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012 172 1211 1218. doi: 10.1001/archinternmed.2012.3698
20. Mueller C, Giannitsis E, Christ M, Ordóñez-Llanos J, deFilippi C, McCord J, Body R, Panteghini M, Jernberg T, Plebani M, Verschuren F, French J, Christenson R, Weiser S, Bendig G, Dilba P, Lindahl B, TRAPID-AMI Investigators Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Ann Emerg Med 2016 68 76 87.e4. doi: 10.1016/j.annemergmed.2015.11.013
21. Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA, Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 2010 56 254 261. doi: 10.1373/clinchem.2009.132654
22. Mueller C, Biomarkers and acute coronary syndromes: an update. Eur Heart J 2014 35 552 556. doi: 10.1093/eurheartj/eht530
23. Hammarsten O, Fu ML, Sigurjonsdottir R, Petzold M, Said L, Landin-Wilhelmsen K, Widgren B, Larsson M, Johanson P, Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction. Clin Chem 2012 58 628 637. doi: 10.1373/clinchem.2011.171496
24. Diamond GA, Forrester JS, Analysis of probability as an aid in the clinical diagnosis of coronary-Artery disease. N Engl J Med 1979 300 1350 1358. doi: 10.1056/NEJM197906143002402
25. Chun AA, McGee SR, Bedside diagnosis of coronary artery disease: a systematic review. Am J Med 2004 117 334 343. doi: 10.1016/j.amjmed.2004.03.021
26. Body R, Carley S, Wibberley C, McDowell G, Ferguson J, Mackway-Jones K, The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation 2010 81 281 286. doi: 10.1016/j.resuscitation.2009.11.014
27. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction Third universal definition of myocardial infarction. Circulation 2012 126 2020 2035. doi: 10.1161/CIR.0b013e31826e1058
28. Reichlin T, Irfan A, Twerenbold R, Reiter M, Hochholzer W, Burkhalter H, Bassetti S, Steuer S, Winkler K, Peter F, Meissner J, Haaf P, Potocki M, Drexler B, Osswald S, Mueller C, Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation 2011 124 136 145. doi: 10.1161/CIRCULATIONAHA.111.023937
29. Hartsell S, Dorais J, Preston R, Hamilton D, Fuller M, Mallin M, Barton E, Madsen T, False-positive rates of provocative cardiac testing in chest pain patients admitted to an emergency department observation unit. Crit Pathw Cardiol 2014 13 104 108. doi: 10.1097/HPC.0000000000000018
30. Goldstein JA, Chinnaiyan KM, Abidov A, Achenbach S, Berman DS, Hayes SW, Hoffmann U, Lesser JR, Mikati IA, O'Neil BJ, Shaw LJ, Shen MY, Valeti US, Raff GL, CT-STAT Investigators The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol 2011 58 1414 1422. doi: 10.1016/j.jacc.2011.03.068
31. Litt HI, Gatsonis C, Snyder B, Singh H, Miller CD, Entrikin DW, Leaming JM, Gavin LJ, Pacella CB, Hollander JE, CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med 2012 366 1393 1403. doi: 10.1056/NEJMoa1201163
32. Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, Nagurney JT, Pope JH, Hauser TH, White CS, Weiner SG, Kalanjian S, Mullins ME, Mikati I, Peacock WF, Zakroysky P, Hayden D, Goehler A, Lee H, Gazelle GS, Wiviott SD, Fleg JL, Udelson JE, ROMICAT-II Investigators Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 2012 367 299 308. doi: 10.1056/NEJMoa1201161
33. Brenner DJ, Hall EJ, Computed tomography-An increasing source of radiation exposure. N Engl J Med 2007 357 2277 2284. doi: 10.1056/NEJMra072149
34. Berrington de Gonzalez A, Mahesh M, Kim KP, Bhargavan M, Lewis R, Mettler F, Land C, Projected cancer risks from computed tomographic scans performed in the united states in 2007. Arch Intern Med 2009 169 2071 2077. doi: 10.1001/archinternmed.2009.440
35. Than M, Herbert M, Flaws D, Cullen L, Hess E, Hollander JE, Diercks D, Ardagh MW, Kline JA, Munro Z, Jaffe A, What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the Emergency Department?: a clinical survey. Int J Cardiol 2013 166 752 754. doi: 10.1016/j.ijcard.2012.09.171
36. Mahler SA, Riley RF, Hiestand BC, Russell GB, Hoekstra JW, Lefebvre CW, Nicks BA, Cline DM, Askew KL, Elliott SB, Herrington DM, Burke GL, Miller CD, The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes 2015 8 195 203. doi: 10.1161/CIRCOUTCOMES.114.001384
37. Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, Flaws D, Hammett CJ, Beam DM, Ardagh MW, Troughton R, Brown AF, George P, Florkowski CM, Kline JA, Peacock WF, Maisel AS, Lim SH, Lamanna A, Richards AM, 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012 59 2091 2098. doi: 10.1016/j.jacc.2012.02.035
38. Cullen L, Mueller C, Parsonage WA, Wildi K, Greenslade JH, Twerenbold R, Aldous S, Meller B, Tate JR, Reichlin T, Hammett CJ, Zellweger C, Ungerer JP, Rubini Gimenez M, Troughton R, Murray K, Brown AF, Mueller M, George P, Mosimann T, Flaws DF, Reiter M, Lamanna A, Haaf P, Pemberton CJ, Richards AM, Chu K, Reid CM, Peacock WF, Jaffe AS, Florkowski C, Deely JM, Than M, Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 2013 62 1242 1249. doi: 10.1016/j.jacc.2013.02.078
39. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E, The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 2000 284 835 842
40. Jaffery Z, Hudson MP, Jacobsen G, Nowak R, McCord J, Modified thrombolysis in myocardial infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. J Thromb Thrombolysis 2007 24 137 144. doi: 10.1007/s11239-007-0013-0
41. Boubaker H, Beltaief K, Grissa MH, Kerkeni W, Dridi Z, Msolli MA, Chouchene H, Belaid A, Chouchene H, Sassi M, Bouida W, Boukef R, Methemmem M, Marghli S, Nouira S, Great Network Inaccuracy of thrombolysis in myocardial infarction and global registry in acute coronary events scores in predicting outcome in ed patients with potential ischemic chest pain. Am. J. Emerg. Med 2015 33 1209 1212. doi: 10.1016/j.ajem.2015.05.019
42. Kazi DS, Hlatky MA, Repeat revascularization is a faulty end point for clinical trials. Circ Cardiovasc Qual Outcomes 2012 5 249 250. doi: 10.1161/CIRCOUTCOMES.112.965764
43. Kaul S, Diamond GA, Trial and error. How to avoid commonly encountered limitations of published clinical trials. J Am Coll Cardiol 2010 55 415 427. doi: 10.1016/j.jacc.2009.06.065
44. D'Souza M, Sarkisian L, Saaby L, Poulsen TS, Gerke O, Larsen TB, Diederichsen AC, Jangaard N, Diederichsen SZ, Hosbond S, Hove J, Thygesen K, Mickley H, Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays. Am J Med 2015 128 852 860. doi: 10.1016/j.amjmed.2015.01.044
45. Braunwald E, Morrow DA, Unstable angina: is it time for a requiem? Circulation 2013 127 2452 2457. doi: 10.1161/CIRCULATIONAHA.113.001258
46. Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G, GRACE Investigators Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest 2004 126 461 469. doi: 10.1378/chest.126.2.461
47. Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, Ornato JP, Barron HV, Kiefe CI, Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA 2000 283 3223 3229
48. Carlton EW, Khattab A, Greaves K, Identifying patients suitable for discharge after a single-presentation high-sensitivity troponin result: a comparison of five established risk scores and two high-sensitivity assays. Ann Emerg Med 2015 66 635 645.e1. doi: 10.1016/j.annemergmed.2015.07.006