Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

James McCord¹, Rafael Cabrera², Bertil Lindahl², Evangelos Giannitsis², Kaleigh Evans², Richard Nowak², Tiberio Frisoli², Richard Body², Michael Christ², Christopher R deFilippi², Robert H Christenson², Gordon Jacobsen², Aitor Alquezar², Mauro Panteghini², Dina Melki², Mario Plebani², Franck Verschuren², John French², Garnet Bendig², Silvia Weiser², Christian Mueller²; TRAPID-AMI Investigators

Collaborators, Affiliations

Collaborators

TRAPID-AMI Investigators:
Raphael Twerenbold, Hugo A Katus, Steffen Popp, Jorge Ordóñez-Llanos, Miquel Santalo-Bel, Daniel Horner, Alberto Dolci, Tomas Jernberg, Martina Zaninotto, Alessandro Manara, Carina Dinkel, Sylvie Menassanch-Volker, Jochen Jarausch, Christian Zaugg

Affiliations

¹ From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.). jmccord1@hfhs.org.
² From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).

PMID: 28167641
DOI: 10.1161/CIRCOUTCOMES.116.003101

Clinical Trial

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

James McCord et al. Circ Cardiovasc Qual Outcomes. 2017 Feb.

. 2017 Feb;10(2):e003101.

doi: 10.1161/CIRCOUTCOMES.116.003101.

Authors

Collaborators

TRAPID-AMI Investigators:
Raphael Twerenbold, Hugo A Katus, Steffen Popp, Jorge Ordóñez-Llanos, Miquel Santalo-Bel, Daniel Horner, Alberto Dolci, Tomas Jernberg, Martina Zaninotto, Alessandro Manara, Carina Dinkel, Sylvie Menassanch-Volker, Jochen Jarausch, Christian Zaugg

Affiliations

¹ From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.). jmccord1@hfhs.org.
² From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).

PMID: 28167641
DOI: 10.1161/CIRCOUTCOMES.116.003101

Abstract

Background: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.

Methods and results: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).

Conclusions: Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.

Keywords: mortality; myocardial i; nfarction; patient discharge; prognosis; troponin-T.

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Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Collaborators

Affiliations

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

Substances

Grants and funding