Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Department of Cardiology, the First Hospital of Qinhuangdao, Hebei Medical University, Hebei, China.
Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Geriatr Cardiol. 2016 Jan;13(1):64-9. doi: 10.11909/j.issn.1671-5411.2016.01.013.
To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED).
This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation.
A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diagnosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progressive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 by χ (2) for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0-2), intermediate risk (score 3-4), and high risk (score 5-10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001).
The modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.
验证改良的 HEART（病史、心电图（ECG）、年龄、危险因素和肌钙蛋白）评分在急诊科（ED）疑似非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）胸痛患者中的有效性。
本回顾性队列研究使用前瞻性采集的数据库，纳入因疑似 NSTE-ACS 而被收入 ED 的胸痛患者。使用 ED 就诊时记录的数据。除传统肌钙蛋白 I 外，还检测了 HEART 风险评分中使用的高敏肌钙蛋白 I 的血清样本。计算改良的 HEART 风险评分。终点是主要不良心脏事件（MACE）的发生，定义为初始表现后三个月内急性心肌梗死（AMI）、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）或全因死亡的复合事件。
共纳入 1300 例患者。共有 606 例（46.6%）患者在三个月内发生 MACE：205 例（15.8%）患者被诊断为 AMI，465 例（35.8%）患者接受了 PCI，119 例（9.2%）患者接受了 CABG。有 10 例（0.8%）患者死亡。随着评分的增加，观察到事件发生率呈逐渐显著增加的趋势（趋势检验 χ²值<0.001）。受试者工作特征曲线下面积为 0.84。所有患者被分为三组：低危（评分 0-2）、中危（评分 3-4）和高危（评分 5-10）。各组的事件发生率分别为 1.1%、18.5%和 67.0%（P<0.001）。
改良的 HEART 风险评分在疑似 NSTE-ACS 的胸痛患者中得到验证，可补充 ED 中 MACE 风险评估和患者分诊。需要前瞻性研究该评分。
