Aktemur Mehmet Ragip, Songur Kodik Meltem, Capar Aktemur Fatma Naile, Aksay Ersin, Ersel Murat
Department of Emergency Medicine, Ercis Sehit Ridvan Cevik State Hospital, Van, Turkey.
Department of Emergency Medicine, Faculty of Medicine, Ege University, Izmir, Turkey.
Medicine (Baltimore). 2025 Feb 7;104(6):e41432. doi: 10.1097/MD.0000000000041432.
This study evaluated the effectiveness of history, electrocardiogram, age, risk factors, and troponin (HEART), troponin-only Manchester acute coronary syndromes (T-MACS), and history and electrocardiogram-only Manchester acute coronary syndromes (HE-MACS) in diagnosing and managing acute coronary syndrome in patients presenting with chest pain in the emergency department. These scoring systems are crucial for risk stratification and the prediction of major adverse cardiac events (MACEs) and mortality within 30 days. A single-center prospective analytical study was conducted following the STROBE guidelines, with 560 patients presenting with chest pain or ischemic equivalent symptoms at the Ege University Faculty of Medicine Hospital from August 2020 to March 2021. The HEART, T-MACS, and HE-MACS scores were calculated for each patient, and their predictive values for MACE and mortality were analyzed using receiver operating characteristic analysis. The HEART score demonstrated an area under the curve (AUC) of 0.929 for predicting mortality, with 100% sensitivity and 81% specificity. It has been identified as the most reliable predictor of mortality. The T-MACS score showed an AUC of 0.875 for mortality prediction with 85.7% sensitivity and 83.9% specificity. It is particularly effective for high-risk patients, predicting 30-day MACE development rates, which is consistent with the literature. The HE-MACS score yielded an AUC of 0.729 for mortality prediction, with 71.4% sensitivity and 80.7% specificity. Although it effectively excludes MACE in very-low-risk patients, it is limited by its application to a highly isolated group. The discussion interprets the results and compares them with existing literature. The study confirms the high effectiveness of the HEART score in mortality risk assessment, the specificity of the T-MACS score for high-risk patients, and the utility of the HE-MACS score for excluding very-low-risk cases. The limitations of each scoring system are discussed and recommendations for their application in clinical practice are provided. The study concluded that selecting the most appropriate scoring system based on individual patient characteristics is essential for optimal patient management in the emergency department. For optimal patient management, it is essential to select the most appropriate scoring system based on the individual patient characteristics.
本研究评估了病史、心电图、年龄、风险因素和肌钙蛋白（HEART）评分系统、仅肌钙蛋白的曼彻斯特急性冠状动脉综合征（T-MACS）评分系统以及仅病史和心电图的曼彻斯特急性冠状动脉综合征（HE-MACS）评分系统在急诊科胸痛患者急性冠状动脉综合征诊断和管理中的有效性。这些评分系统对于风险分层以及预测30天内的主要不良心脏事件（MACE）和死亡率至关重要。按照STROBE指南进行了一项单中心前瞻性分析研究，2020年8月至2021年3月期间，在伊兹密尔大学医学院医院有560例出现胸痛或缺血等效症状的患者纳入研究。为每位患者计算HEART、T-MACS和HE-MACS评分，并使用受试者工作特征分析来分析它们对MACE和死亡率的预测价值。HEART评分在预测死亡率方面曲线下面积（AUC）为0.929，敏感性为100%，特异性为81%。它已被确定为最可靠的死亡率预测指标。T-MACS评分预测死亡率的AUC为0.875，敏感性为85.7%，特异性为83.9%。它对高危患者特别有效，能预测30天MACE发生率，这与文献一致。HE-MACS评分预测死亡率的AUC为0.729，敏感性为71.4%，特异性为80.7%。虽然它能有效排除极低风险患者的MACE，但因其应用于高度孤立的群体而受到限制。讨论部分对结果进行了解释，并与现有文献进行了比较。该研究证实了HEART评分在死亡率风险评估中的高效性、T-MACS评分对高危患者的特异性以及HE-MACS评分在排除极低风险病例方面的效用。讨论了每个评分系统的局限性，并提供了它们在临床实践中应用的建议。研究得出结论，根据个体患者特征选择最合适的评分系统对于急诊科患者的最佳管理至关重要。为实现最佳患者管理，根据个体患者特征选择最合适的评分系统至关重要。
