Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Am J Emerg Med. 2023 Dec;74:104-111. doi: 10.1016/j.ajem.2023.09.037. Epub 2023 Oct 1.
The History, Electrocardiogram (ECG), Age, Risk factors and Troponin, (HEART) score is useful for early risk stratification in chest pain patients. The aim was to validate previous findings that a simplified score using history, ECG and troponin (HET-score) has similar ability to stratify risk.
Patients presenting with chest pain with duration of ≥10 min and an onset of last episode ≤12 h but without ST-segment elevation on ECG at 6 emergency departments were eligible for inclusion. The HEART-score and the simplified HET-score were calculated. The endpoint was a composite of myocardial infarction (MI) as index diagnosis, readmission due to new MI or death within 30 days.
HEART-score identified 32% as low risk (0-2p), 47% as intermediate risk (3-5p), and 20% as high risk (6-10p) patients. The endpoint occurred in 0.5%, 7.3% and 35.7%, respectively. HET-score identified 39%, 42% and 19% as low- (0p), intermediate- (1-2p) and high-risk (3-6p) patients, with the endpoint occurring in 0.6%, 6.2% and 43.2%, respectively. When all variables included in the HEART-score were included in a multivariable logistic regression analysis, only History (OR, CI [95%]): 2.97(2.16-4.09), ECG (1.61[1.14-2.28]) and troponin level (5.21[3.91-6.95]) were significantly associated with cardiovascular events. When HEART- and HET-score were compared in a ROC-analysis, HET-score had a significantly larger AUC (0.887 vs 0.853, p < 0.001).
Compared with HEART-score, HET-score is simpler and appears to have similar ability to discriminate between chest pain patients with and without cardiovascular event.
历史、心电图（ECG）、年龄、危险因素和肌钙蛋白（HEART）评分可用于胸痛患者的早期风险分层。目的是验证之前的发现，即使用病史、心电图和肌钙蛋白的简化评分（HET 评分）具有相似的分层风险能力。
在 6 个急诊科，符合纳入标准的胸痛患者为胸痛持续时间≥10 分钟且最后一次发作时间≤12 小时，但心电图无 ST 段抬高。计算 HEART 评分和简化 HET 评分。终点是心肌梗死（MI）作为指标诊断、因新发 MI 再入院或 30 天内死亡的复合终点。
HEART 评分将 32%的患者评为低危（0-2 分），47%的患者评为中危（3-5 分），20%的患者评为高危（6-10 分）。终点发生率分别为 0.5%、7.3%和 35.7%。HET 评分将 39%、42%和 19%的患者评为低危（0 分）、中危（1-2 分）和高危（3-6 分），终点发生率分别为 0.6%、6.2%和 43.2%。当 HEART 评分中包含的所有变量都包含在多变量逻辑回归分析中时，只有病史（OR，CI [95%]）：2.97（2.16-4.09）、心电图（1.61[1.14-2.28]）和肌钙蛋白水平（5.21[3.91-6.95]）与心血管事件显著相关。当在 ROC 分析中比较 HEART 和 HET 评分时，HET 评分的 AUC 显著更大（0.887 对 0.853，p<0.001）。
与 HEART 评分相比，HET 评分更简单，似乎具有相似的能力来区分有和无心血管事件的胸痛患者。
