Marmara University School of Medicine, Department of Emergency Medicine, Istanbul, Turkey.
Specialist of Emergency Medicine, Marmara University Pendik Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
Am J Emerg Med. 2024 Jun;80:24-28. doi: 10.1016/j.ajem.2024.02.041. Epub 2024 Mar 7.
We aimed to compare the predictive ability of the newly introduced Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) score with the widely used History, ECG, Age, Risk factors, and Troponin I (HEART) score in risk stratification for 30-day major adverse cardiac events (MACE) development among patients presenting to the emergency department with acute chest pain complaints.
This prospective, observational, single-center study was conducted at an emergency department of a tertiary care hospital between June 2022 and January 2023. We recruited all adult patients aged 24 years and above with a primary complaint of non- traumatic chest pain at the critical care unit of the Emergency Department.
Patients aged 24 years and above with a primary complaint of chest pain lasting >5 min.
Patients with STEMI, pregnant individuals, those with traumatic chest pain, and those without 30-day MACE data were excluded. HEART and SVEAT scores were calculated for each participant.The performance of the SVEAT score in identifying the low-risk patient group was compared to that of the HEART score.
In the study, out of 809 patients, 589 (72.8%) were categorized as low-risk based on the SVEAT score, and 377 (46.6%) based on the HEART score. Out of these 809 patients, 115 (14.2%) experienced MACE. Within the group classified as low risk by the SVEAT score, 6 (0.7%) patients experienced MACE, while within the group classified as low risk by the HEART score, 8 (1%) patients experienced MACE. The SVEAT score had an Area Under the Curve (AUC) of 0.916 (95% CI 0.890 to 0.942), which was found to be higher than the AUC of the HEART score (0.856, 95% CI 0.822 to 0.890). In our study, the sensitivity of the SVEAT and HEART scores was found to be 94.7% (95% CI 88.9%-98.0%) and 93.0% (95% CI 86.7%-96.9%), respectively. The specificity of both scores was 84.1% (95% CI 81.0%-86.6%) and 53.17% (95% CI 49.3%-56.6%), respectively.
While our study indicated a higher predictive power for MACE development with the SVEAT score compared to the HEART score, further extensive studies are necessary for its reliable implementation in emergency departments for chest pain risk classification.
本研究旨在比较新引入的症状、血管疾病史、心电图、年龄和肌钙蛋白（SVEAT）评分与广泛使用的病史、心电图、年龄、危险因素和肌钙蛋白 I（HEART）评分在预测因急性胸痛就诊于急诊科的患者 30 天内主要不良心脏事件（MACE）发展风险方面的能力。
本前瞻性、观察性、单中心研究于 2022 年 6 月至 2023 年 1 月在一家三级护理医院的急诊科进行。我们招募了所有年龄在 24 岁及以上、因非创伤性胸痛在急诊科重症监护室就诊的成年患者。
年龄在 24 岁及以上，胸痛持续时间>5 分钟。
ST 段抬高型心肌梗死患者、孕妇、创伤性胸痛患者以及无 30 天 MACE 数据的患者被排除在外。为每位参与者计算 HEART 和 SVEAT 评分。比较 SVEAT 评分在确定低危患者人群中的表现与 HEART 评分。
在这项研究中，809 名患者中，589 名（72.8%）根据 SVEAT 评分、377 名（46.6%）根据 HEART 评分被归类为低危。在这 809 名患者中，有 115 名（14.2%）发生了 MACE。在 SVEAT 评分中被归类为低危的患者中，有 6 名（0.7%）发生了 MACE，而在 HEART 评分中被归类为低危的患者中，有 8 名（1%）发生了 MACE。SVEAT 评分的曲线下面积（AUC）为 0.916（95%CI 0.890-0.942），高于 HEART 评分的 AUC（0.856，95%CI 0.822-0.890）。在我们的研究中，SVEAT 和 HEART 评分的敏感性分别为 94.7%（95%CI 88.9%-98.0%）和 93.0%（95%CI 86.7%-96.9%）。这两个评分的特异性分别为 84.1%（95%CI 81.0%-86.6%）和 53.17%（95%CI 49.3%-56.6%）。
虽然我们的研究表明 SVEAT 评分在预测 MACE 方面比 HEART 评分具有更高的预测能力，但需要进一步进行广泛的研究，以使其在急诊科胸痛风险分类中可靠实施。
