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Multicenter Study
. 2021 Nov 19;21(1):555.
doi: 10.1186/s12872-021-02381-z.

30 day predicted outcome in undifferentiated chest pain: multicenter validation of the HEART score in Tunisian population

Mohamed Hassene Khalil  1   2 , Adel Sekma  3   4 , Hajer Yaakoubi  5   4 , Khaoula Bel Haj Ali  3   4 , Mohamed Amine Msolli  3   4 , Kaouthar Beltaief  3   4 , Mohamed Habib Grissa  3   4 , Hamdi Boubaker  3   4 , Mohamed Sassi  3   4 , Hamadi Chouchene  3   4 , Youssef Hassen  3   4 , Houda Ben Soltane  4   6 , Zied Mezgar  4   6 , Riadh Boukef  5   4 , Wahid Bouida  3   4 , Semir Nouira  3   4
Affiliations
Multicenter Study

30 day predicted outcome in undifferentiated chest pain: multicenter validation of the HEART score in Tunisian population

Mohamed Hassene Khalil et al. BMC Cardiovasc Disord. .

Abstract

Background: Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one.

Objective: To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain.

Methods: Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer-Lemeshow goodness of test.

Results: We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85-0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03).

Conclusion: HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population.

Keywords: Admission avoidance; Chest pain; Emergency service; Myocardial infarction; Severity of illness index.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the inclusion process
Fig. 2
Fig. 2
Patients’ distribution in each risk group of HEART score
Fig. 3
Fig. 3
MACE rate in each HEART score Group
Fig. 4
Fig. 4
Receiver operating characteristic curve for HEART score in predicting MACE at 30 days. AUC = 0.87, 95% CI: 0.85 to 0.88
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