Six A Jacob, Cullen Louise, Backus Barbra E, Greenslade Jaimi, Parsonage William, Aldous Sally, Doevendans Pieter A, Than Martin
Hofpoort Zuwe Ziekenhuis, GN Woerden, Utrecht, The Netherlands.
Crit Pathw Cardiol. 2013 Sep;12(3):121-6. doi: 10.1097/HPC.0b013e31828b327e.
The HEART score for the early risk stratification of patients presenting to the emergency department with chest pain contains 5 elements: history, electrocardiogram, age, risk factors, and troponin. It has been validated in The Netherlands. The purpose of this investigation was to perform an external validation of the HEART score in an Asia-Pacific population.
Data were used from 2906 patients presenting with chest pain to the emergency departments of 14 hospitals. HEART scores were determined retrospectively. Three risk groups were composed based on previous research. The predictive values for the occurrence of 30-day major adverse coronary events (MACE) were assessed. A comparison was made with the Thrombolysis in Myocardial Infarction (TIMI) score in terms of the value of C-statistics.
The low-risk group, HEART score ≤ 3, consisted of 820/2906 patients (28.2%). Fourteen (1.7%) patients were incorrectly defined as low risk (false negatives). The high-risk population, HEART score 7-10, consisted of 464 patients (16%) with a risk of MACE of 43.1%. The C-statistics were 0.83 (0.81-0.85) for HEART and 0.75 (0.72-0.77) for TIMI (P < 0.01).
Utilization of the HEART score provided excellent determination of risk for 30-day MACE, comparing well with the Thrombolysis in Myocardial Infarction score. This study externally validates previous findings that HEART is a powerful clinical tool in this setting. It quickly identifies both a large proportion of low-risk patients, in whom early discharge without additional testing goes with a risk of MACE of only 1.7%, and high-risk patients who are potential candidates for early invasive strategies.
用于对因胸痛就诊于急诊科的患者进行早期风险分层的HEART评分包含5个要素：病史、心电图、年龄、危险因素和肌钙蛋白。该评分已在荷兰得到验证。本研究的目的是在亚太人群中对HEART评分进行外部验证。
使用了来自14家医院急诊科的2906例胸痛患者的数据。回顾性确定HEART评分。根据先前的研究划分出三个风险组。评估30天主要不良冠状动脉事件（MACE）发生的预测值。就C统计量的值与心肌梗死溶栓（TIMI）评分进行比较。
低风险组，HEART评分≤3，包括820/2906例患者（28.2%）。14例（1.7%）患者被错误地定义为低风险（假阴性）。高风险人群，HEART评分7 - 10，包括464例患者（16%），MACE风险为43.1%。HEART评分的C统计量为0.83（0.81 - 0.85），TIMI评分为0.75（0.72 - 0.77）（P < 0.01）。
与心肌梗死溶栓评分相比，使用HEART评分能很好地确定30天MACE的风险。本研究从外部验证了先前的发现，即HEART在这种情况下是一种强大的临床工具。它能快速识别出很大一部分低风险患者，这些患者无需进一步检查即可早期出院，其MACE风险仅为1.7%，同时也能识别出高风险患者，这些患者是早期侵入性策略的潜在候选者。
