Han Changsung, Chung Heajin, Lee Youngjoo, Jang Hye Young, Cho Young Shin, Park Junbum, Kim Sang-Il
Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Clin Exp Emerg Med. 2020 Dec;7(4):267-274. doi: 10.15441/ceem.19.084. Epub 2020 Dec 31.
Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS).
We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis.
Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627-0.776) and 0.737 (95% confidence interval, 0.660-0.804) for SCS.
HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.
对于出现缺血症状的患者，在急诊科（ED）快速诊断急性冠状动脉综合征（ACS）非常重要。本研究的目的是确定HEART评分对ACS和严重冠状动脉狭窄（SCS）的预测价值。
我们回顾性分析了因胸痛就诊于ED并入住心内科的患者数据。根据出院诊断将入选患者分为ACS组和非ACS组。接受影像学检查的患者根据检查结果进一步分为SCS组和非SCS组。我们比较了每组患者的年龄、性别、生命体征、危险因素、心电图、肌钙蛋白和HEART评分。对于ACS和SCS的预测性能，使用敏感性、特异性、预测值、似然比和受试者工作特征（ROC）曲线分析来计算HEART评分的检验特征。
207例患者中，112例患有ACS。入选患者中，155例接受了影像学检查，其中67例患有SCS。HEART评分≤3对ACS的敏感性为93%，对SCS的敏感性为97%。HEART评分≥7对ACS的特异性为82%，对SCS的特异性为83%。ACS的ROC曲线下HEART评分面积为0.706（95%置信区间，0.627 - 0.776），SCS为0.737（95%置信区间，0.660 - 0.804）。
对于因胸痛就诊于ED并入住心内科的患者，HEART评分是ACS和SCS的一个较好预测指标。HEART评分对SCS的预测能力优于对ACS的预测能力。
