Short-and long-term prognostic utility of the HEART score in patients evaluated in the emergency department for possible acute coronary syndrome

Introduction: the Heart score is a risk-stratification tool that was developed and validated for patients evaluated for possible acute coronary syndrome (acS) in the emergency department (eD). We sought to determine the short-term and long-term prognostic utility of the Heart score. Methods: a retrospective single-center analysis of 947 patients evaluated for possible acS in the eD in 1999 was conducted. Patients were followed for major adverse cardiac events (Maces) at 30 days: death, acute myocardial infarction, or revascularization procedure. all-cause mortality was assessed at 5 years. the Heart score was compared with the thrombolysis in Myocardial infarction (tiMi) score. Results: at 30 days, 14% (135/947) of patients had an Mace: 48 deaths (5%), 84 acute myocardial infarctions (9%), and 48 (5%) revascularization procedures. the Mace rate in patients with Heart score ≤3 was 0.6% (1/175) involving a revascularization procedure, 9.5% (53/557) in patients with Heart score between 4 and 6, and 38% (81/215) with Heart score ≥7. the c-statistic for the Heart score was 0.82 and 0.68 for the tiMi score for predicting 30-day Mace (P < 0.05). Patients with Heart score ≤3 had lower 5-year mortality rate compared with those with tiMi score of 0 (10.6% vs. 20.5%, P = 0.02). Conclusions: the Heart score is a valuable risk-stratification tool in predicting not only short-term Mace but also long-term mortality in patients evaluated for possible acS in the eD. the Heart score had a superior prognostic value compared with the tiMi score.