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Risk stratification of chest pain in a Portuguese Emergency Department: is the Heart Score appropriate?
Session:
Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker:
Margarida S. Cabral
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida Cabral; André Martins; Carolina Gonçalves; Adriana Vazão; Mariana Carvalho; Catarina Ruivo; João Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Chest pain (CH) is one of the main symptoms of all emergency department (ED) admissions in developed countries. Early rule in or rule out of acute coronary syndrome (ACS) is the crucial step in patient evaluation. There are several risk stratification scoring systems for ACS, with the HEART score being an easy and quick score, originally developed in an ED setting.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective study analysed the first two hundred and four patients admitted to the ED of a health local unit in Portugal with CP and classified by the Manchester system with very urgent (orange) priority in 2022. ST-segment elevation myocardial infarction, traumatic CP, and those associated with the postoperative period of cardiothoracic surgery were excluded. Patients are divided into low-risk (score 0–3), intermediate-risk (score 4–6), and high-risk (score 7–10) according to the HEART score. Patients diagnosed with unstable angina and myocardial infarction were classified in the ACS group and all others were classified as non-ACS. According to cardiac catheterization, patients were also classified in the significant coronary artery stenosis (SCS) group (group 1) with 70% or greater coronary artery stenosis and the non-SCS group. Group 2 includes the non-SCS and the non-ACS patients. Group comparisons were performed. A p-value less than 0.05 is statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In 2022, 1662 patients were admitted due to “very urgent” CP, which corresponded to 4.5 patients by day. Of the 195 patients, 48.7% (95) were male and the mean age was 57.6 years. The baseline characteristics are described in Table 1. Twenty-one (10.8%) had ACS suspected, and 13 (6.7%) presented an SCS (Figure 1). The heart score system revealed adequate discrimination for the presence of SCS (area under the curve=0.835 [95% confidence interval, 0.700–0.971], p-value<0.01), with a sensitivity of 53.8% and specificity of 95.10% to a score higher than 6.5 (Table 1 and Figure 2). It is not suitable for discriminating patients with an intermediate score, in whom high-sensitivity troponin measurement is essential.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In conclusion, in our population, the Heart Score is a very useful prediction tool for SCS. Taking into account the high number of non-ischemic chest pain in our ED, this score may be a useful tool to identify patients who truly require earlier angiography and revascularization. These results should be confirmed on a large scale and in a multicenter manner.</span></span></p>
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