Predictors of major adverse cardiac events among patients with chest pain and low HEART score in the emergency department
Copyright © 2023 Elsevier B.V. All rights reserved..
AIM: For patients who present to the emergency departments (ED) with undifferentiated chest pain, the risk of major adverse cardiac events (MACE) may be underestimated in low-HEART score patients. We aimed to identify characteristics of patients who were classified as low risk by HEART score but subsequently developed MACE at 6 weeks.
METHODS: We studied a multiethnic cohort of patients who presented with chest pain arousing suspicion of acute coronary syndrome to EDs in the Netherlands and Singapore. Patients were risk-stratified using HEART score and followed up for MACE at 6 weeks. Risk factors of developing MACE despite low HEART scores (scores 0-3) were identified using logistic and Cox regression models.
RESULTS: Among 1376 (39.8%) patients with low HEART scores, 63 (4.6%) developed MACE at 6 weeks. More males (53/806, 6.6%) than females (10/570, 2.8%) with low HEART score developed MACE. There was no difference in outcomes between ethnic groups. Among low-HEART score patients with 2 points for history, 21% developed MACE. Among low-HEART score patients with 1 point for troponin, 50% developed MACE, while 100% of those with 2 points for troponin developed MACE. After adjusting for HEART score and potential confounders, male sex was independently associated with increased odds (OR 4.12, 95%CI 2.14-8.78) and hazards (HR 3.93, 95%CI 1.98-7.79) of developing MACE despite low HEART score.
CONCLUSION: Male sex, highly suspicious history and elevated troponin were disproportionately associated with MACE. These characteristics should prompt clinicians to consider further investigation before discharge.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 2023 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:395 |
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| Enthalten in: |
International journal of cardiology - 395(2023) vom: 15. Jan., Seite 131573 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ho, Andrew Fu Wah [VerfasserIn] |
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| Anmerkungen: |
Date Completed 16.12.2023 Date Revised 16.12.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2023.131573 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364234687 |
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| 100 | 1 | |a Ho, Andrew Fu Wah |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictors of major adverse cardiac events among patients with chest pain and low HEART score in the emergency department |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 16.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a AIM: For patients who present to the emergency departments (ED) with undifferentiated chest pain, the risk of major adverse cardiac events (MACE) may be underestimated in low-HEART score patients. We aimed to identify characteristics of patients who were classified as low risk by HEART score but subsequently developed MACE at 6 weeks | ||
| 520 | |a METHODS: We studied a multiethnic cohort of patients who presented with chest pain arousing suspicion of acute coronary syndrome to EDs in the Netherlands and Singapore. Patients were risk-stratified using HEART score and followed up for MACE at 6 weeks. Risk factors of developing MACE despite low HEART scores (scores 0-3) were identified using logistic and Cox regression models | ||
| 520 | |a RESULTS: Among 1376 (39.8%) patients with low HEART scores, 63 (4.6%) developed MACE at 6 weeks. More males (53/806, 6.6%) than females (10/570, 2.8%) with low HEART score developed MACE. There was no difference in outcomes between ethnic groups. Among low-HEART score patients with 2 points for history, 21% developed MACE. Among low-HEART score patients with 1 point for troponin, 50% developed MACE, while 100% of those with 2 points for troponin developed MACE. After adjusting for HEART score and potential confounders, male sex was independently associated with increased odds (OR 4.12, 95%CI 2.14-8.78) and hazards (HR 3.93, 95%CI 1.98-7.79) of developing MACE despite low HEART score | ||
| 520 | |a CONCLUSION: Male sex, highly suspicious history and elevated troponin were disproportionately associated with MACE. These characteristics should prompt clinicians to consider further investigation before discharge | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Clinical epidemiology | |
| 650 | 4 | |a HEART score | |
| 650 | 7 | |a Troponin |2 NLM | |
| 700 | 1 | |a Yau, Chun En |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Jamie Sin-Ying |e verfasserin |4 aut | |
| 700 | 1 | |a Lim, Swee Han |e verfasserin |4 aut | |
| 700 | 1 | |a Ibrahim, Irwani |e verfasserin |4 aut | |
| 700 | 1 | |a Kuan, Win Sen |e verfasserin |4 aut | |
| 700 | 1 | |a Ooi, Shirley Beng Suat |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Mark Y |e verfasserin |4 aut | |
| 700 | 1 | |a Sia, Ching-Hui |e verfasserin |4 aut | |
| 700 | 1 | |a Mosterd, Arend |e verfasserin |4 aut | |
| 700 | 1 | |a Gijsberts, Crystel M |e verfasserin |4 aut | |
| 700 | 1 | |a de Hoog, Vince C |e verfasserin |4 aut | |
| 700 | 1 | |a Bank, Ingrid E M |e verfasserin |4 aut | |
| 700 | 1 | |a Doevendans, Pieter A |e verfasserin |4 aut | |
| 700 | 1 | |a de Kleijn, Dominique P V |e verfasserin |4 aut | |
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