Department of Acute & Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
Am J Emerg Med. 2021 Jul;45:303-308. doi: 10.1016/j.ajem.2020.08.074. Epub 2020 Aug 27.
HEART score is widely used to stratify patients with chest pain in the emergency department but has never been validated for cocaine-associated chest pain (CACP). We sought to evaluate the performance of HEART score in risk stratifying patients with CACP compared to an age- and sex-matched cohort with non-CACP.
The parent study was an observational cohort study that enrolled consecutive patients with chest pain. We identified patients with CACP and age/sex matched them to patients with non-CACP in 1:2 fashion. HEART score was calculated retrospectively from charts. The primary outcome was major adverse cardiac events (MACE) within 30 days of indexed encounter.
We included 156 patients with CACP and 312 age-and sex-matched patients with non-CACP (n = 468, mean age 51 ± 9, 22% females). There was no difference in rate of MACE between the groups (17.9% vs. 15.7%, p = 0.54). Compared to the non-CACP group, the HEART score had lower classification performance in those with CACP (AUC = 0.68 [0.56-0.80] vs. 0.84 [0.78-0.90], p = 0.022). In CACP group, Troponin score had the highest discriminatory value (AUC = 0.72 [0.60-0.85]) and Risk factors score had the lowest (AUC = 0.47 [0.34-0.59]). In patients deemed low-risk by the HEART score, those with CACP were more likely to experience MACE (14% vs. 4%, OR = 3.7 [1.3-10.7], p = 0.016).
In patients with CACP, HEART score performs poorly in stratifying risk and is not recommended as a rule out tool to identify those at low risk of MACE.
心脏评分广泛用于对急诊科胸痛患者进行分层，但尚未对可卡因相关胸痛（CACP）进行验证。我们旨在评估心脏评分在风险分层 CACP 患者与非 CACP 患者方面的表现。
该研究为一项观察性队列研究，连续纳入胸痛患者。我们从病历中回顾性计算心脏评分，并确定 CACP 患者，并以 1:2 的比例与非 CACP 患者匹配。主要结局是索引就诊后 30 天内的主要不良心脏事件（MACE）。
我们纳入了 156 例 CACP 患者和 312 例年龄和性别匹配的非 CACP 患者（n=468，平均年龄 51±9 岁，22%为女性）。两组之间 MACE 发生率无差异（17.9% vs. 15.7%，p=0.54）。与非 CACP 组相比，心脏评分在 CACP 患者中的分类性能较低（AUC=0.68 [0.56-0.80] vs. 0.84 [0.78-0.90]，p=0.022）。在 CACP 组中，肌钙蛋白评分具有最高的区分价值（AUC=0.72 [0.60-0.85]），危险因素评分最低（AUC=0.47 [0.34-0.59]）。在心脏评分低危的患者中，CACP 患者更有可能发生 MACE（14% vs. 4%，OR=3.7 [1.3-10.7]，p=0.016）。
在 CACP 患者中，心脏评分在分层风险方面表现不佳，不建议将其作为识别低 MACE 风险患者的排除工具。
