Reddy R Hareeth, Srinivasarangan Madhu, Teja B Sai Surya, Jagadeesh Sri Harsha, Basavaraju Brinda
Department of Emergency Medicine, JSS Academy of Higher Education and Research, Mysuru, IND.
Department of General Medicine, Pinnamaneni Siddhartha Medical College, Vijayawada, IND.
Cureus. 2025 Jun 13;17(6):e85966. doi: 10.7759/cureus.85966. eCollection 2025 Jun.
Early diagnosis and effective risk stratification of patients presenting with chest pain who are at a high risk for adverse cardiac outcomes remain priorities in emergency departments (EDs). Major adverse cardiac events (MACE) in this context include myocardial infarction, death, and urgent revascularization procedures. The HEART score, comprising History, ECG, Age, Risk factors, and Troponin, was developed to facilitate rapid and reliable risk assessment. However, shortcomings in emergency care in India, such as limited access to advanced diagnostics and variability in clinical risk assessment, underscore the need for dependable tools validated in local settings. This study aims to address these gaps by providing prospective validation of the HEART score in an Indian tertiary care ED.
The primary objective was to assess the accuracy of the HEART score in predicting MACE within 30 days among adults presenting with chest pain (excluding ST-elevation myocardial infarction). Secondary objectives included evaluating the score's diagnostic validity in guiding clinical decision-making, improving patient disposition accuracy, and optimizing resource utilization, such as reducing unnecessary admissions and invasive testing in the ED setting.
The study was carried out at JSS Hospital's ED in Mysuru, India, from March to November 2022. We analyzed clinical data from 404 patients presenting to the ED with chest pain. Inter-observer variability was minimized by standardized training of clinicians performing the HEART score assessment. High-sensitivity troponin I assays (third generation) were employed to enhance reproducibility. The HEART score's predictive accuracy for MACE, defined as myocardial infarction, death, or urgent revascularization, within 30 days, was evaluated.
Among 404 patients, 325 (80.4%) had low HEART scores (0-3) with a MACE incidence of 0.9% (3/325; p < 0.0001). Intermediate-risk patients (score 4-6) experienced MACE in 28.6% (16/56), while high-risk patients (score 7-10) had an MACE incidence of 89.2% (21/23) (p < 0.0001). These findings align with prior international validations, supporting the HEART score's utility in the Indian ED context.
The HEART score enables effective, rapid risk stratification of chest pain patients, aiding clinical decision-making and potentially reducing unnecessary admissions, radiation exposure, and invasive procedures. This prospective study adds valuable evidence supporting the HEART score's applicability in Indian emergency care, addressing limitations in current risk assessment practices and resource constraints.
对于因胸痛就诊且发生不良心脏事件风险较高的患者，早期诊断和有效的风险分层仍是急诊科的首要任务。在此背景下，主要不良心脏事件（MACE）包括心肌梗死、死亡和紧急血运重建手术。HEART评分由病史、心电图、年龄、危险因素和肌钙蛋白组成，旨在促进快速可靠的风险评估。然而，印度急诊医疗存在不足，如先进诊断手段获取有限以及临床风险评估存在差异，这凸显了在当地环境中验证可靠工具的必要性。本研究旨在通过对印度一家三级医疗急诊科的HEART评分进行前瞻性验证来填补这些空白。
主要目的是评估HEART评分在预测胸痛成人患者（不包括ST段抬高型心肌梗死）30天内发生MACE的准确性。次要目的包括评估该评分在指导临床决策、提高患者处置准确性以及优化资源利用（如减少急诊科不必要的住院和侵入性检查）方面的诊断有效性。
该研究于2022年3月至11月在印度迈索尔的JSS医院急诊科进行。我们分析了404例因胸痛就诊于急诊科患者的临床资料。通过对进行HEART评分评估的临床医生进行标准化培训，将观察者间的变异性降至最低。采用高敏肌钙蛋白I检测（第三代）以提高可重复性。评估了HEART评分在30天内对MACE（定义为心肌梗死、死亡或紧急血运重建）的预测准确性。
在404例患者中，325例（80.4%）HEART评分较低（0 - 3分），MACE发生率为0.9%（3/325；p < 0.0001）。中危患者（评分4 - 6分）的MACE发生率为28.6%（16/56），而高危患者（评分7 - 10分）的MACE发生率为89.2%（21/23）（p < 0.0001）。这些结果与之前的国际验证结果一致，支持了HEART评分在印度急诊科环境中的实用性。
HEART评分能够对胸痛患者进行有效、快速的风险分层，有助于临床决策，并可能减少不必要的住院、辐射暴露和侵入性操作。这项前瞻性研究提供了有价值的证据，支持HEART评分在印度急诊医疗中的适用性，解决了当前风险评估实践中的局限性和资源限制问题。
