Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting with Chest Pain – A Systematic Review and Meta-analysis
CCCF ePoster library. Fernando S. Nov 8, 2018; 233329; 55
Dr. Shannon Fernando
Dr. Shannon Fernando
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Introduction: Risk-stratification of patients presenting with chest pain is crucial for identifying potentially life-threatening outcomes. The HEART (History, Electrocardiogram, Age, Risk factors, Troponin) score has been proposed for prediction of major adverse cardiac events (MACE, a composite outcome including mortality, myocardial infarction, or coronary revascularization) in this population.


Objectives: We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult patients presenting with chest pain. Where available, accuracy of the thrombolysis in myocardial infarction (TIMI) score was determined.  


Methods: We searched six databases (including Medline, EMBASE, and Web of Science) from inception through January 22, 2018. We included English-language studies using the HEART score for the prediction of short-term MACE in adult patients presenting with chest pain. We followed PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Two reviewers independently extracted data and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The main outcome was short-term (i.e. 30-day or 6-week) incidence of MACE.


Results: We included 29 studies (n = 42,650) in pooled analysis. A HEART score above the low-risk threshold (≥4) had a sensitivity of 95.6% (95% confidence interval [CI]: 92.8-97.3) and specificity of 44.0% (95% CI: 38.1-50.0) for MACE, while a TIMI score above the low-risk threshold (≥2) had a sensitivity of 87.6% (95% CI: 78.7-93.1) and specificity of 46.0% (95% CI: 36.7-55.6). A high-risk HEART score (≥7) had a sensitivity of 39.5% (95% CI: 31.6-48.1) and specificity of 95.0% (95% CI: 92.2-96.6) for MACE, while a high-risk TIMI score (≥6) was 2.8% sensitive (95% CI: 0.8-9.6), but 99.6% (95% CI: 98.5-99.9) specific for MACE. The pooled area under the receiver operating characteristic curve for prediction of MACE was 0.81 (95% CI: 0.76-0.86) for the HEART score, and 0.73 (95% CI: 0.68-0.79) for TIMI.   


Conclusions: The HEART score has excellent performance for prediction of MACE in chest pain patients. Clinicians should preferentially utilize the HEART score for risk-stratification of this patient population.


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