ABSTRACT
Background
The 2021 ACC/AHA chest pain guidelines recommend risk scores such as HEAR (History,
Electrocardiogram, Age, Risk Factors) for short term risk-stratification yet limited
data exists integrating them with high-sensitivity cardiac troponin T (hs-cTnT).
Methods
Retrospective, multicenter (n=2), observational, U.S. cohort study of consecutive
ED patients without ST-elevation myocardial infarction (MI) who had at least one hs-cTnT
(limit of quantitation, LoQ, <6 ng/L, and sex-specific 99th percentiles of 10 ng/L for women and 15 ng/L for men) measurement on clinical indications
in whom HEAR scores (0-8) were calculated. The composite major adverse cardiovascular
(MACE) outcome was 30-day prognosis.
Results
Among 1,979 ED patients undergoing hs-cTnT measurement, 1045 (53%) were low-risk (0-3),
914 (46%) intermediate-risk (4-6), and 20 (1%) high-risk (7-8) based on HEAR scores.
HEAR scores were not associated with increased risk of 30-day MACE in adjusted analyses.
Patients with quantifiable hs-cTnT (LoQ-99th) had an increased risk for 30-day MACE (3.4%) irrespective of HEAR scores. Those
with serial hs-cTnT<99th percentile remained at low-risk (range 0% to 1.2%) across all HEAR score strata.
Higher scores were not associated with long term (2-year) events.
Conclusions
HEAR scores are of limited value in those with baseline hs-cTnT<LoQ or hs-cTnT>99th percentile to define short term prognosis. In those with baseline quantifiable hs-cTnT
within the reference range (<99th percentile), a higher risk (>1%) for 30-day MACE exists even in those with low HEAR
scores. With serial hs-cTnT measurements, HEAR scores overestimate risk when hs-cTnT
remains <99th percentile.
Graphical_Abstract
Graphical Abstract
KEY WORDS
Abbreviation:
ACS (acute coronary syndrome), ED (emergency department), HEART (history, electrocardiogram, age, risk factors, and troponin), HEAR (history, electrocardiogram, age, and risk factors), MACE (major adverse cardiovascular events), Hs-cTnT (high-sensitivity cardiac troponin T), Hs-cTn (high-sensitivity cardiac troponin), LoQ (limit of quantitation), URL (upper reference limit)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
April 27,
2023
Received:
April 19,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: Dr. Sandoval has been on advisory boards and a speaker for Abbott Diagnostics and Roche Diagnostics. Dr. Jaffe has consulted or presently consults for most of the major diagnostics companies, including Beckman-Coulter, Abbott, Siemens, ET Healthcare, Ortho Diagnostics, Roche, Radiometer, Sphingotec, RCE Technologies, and Amgen and Novartis. All other authors have nothing to disclose.
Authorship: All authors had access to the data and a role in writing the manuscript. They all have approved the manuscript and have agreed to its publication.
Identification
Copyright
© 2023 Published by Elsevier Inc.
