Fesmire et al modified the HEART score of Six et al for evaluation of an adult in the Emergency Department with chest pain. The authors are from the University of Tennessee and Erlanger Medical Center in Chattanooga.
HEART is an acronym for history, electrocardiogram, age, risk factors and troponin.
Original HEART parameters:
(1) history
(2) ECG changes at baseline
(3) age in years
(4) number of risk factors (diabetes, hypertension, cigarette smoking, hyperlipidemia, family history, obesity)
(5) history of coronary artery disease (CAD)
(6) serum troponin at baseline relative to cutoff (on the Troponin I Axsym Fluormetric Immunoassay, Abbott Laboratories)
Additional parameters for the S3 score:
(1) sex
(2) serial ECG
(3) serial troponin (change or delta at 2 hours)
|
Parameter |
Finding |
Original |
Weighted |
|
history |
chest pain probable not cardiac |
0 |
0 |
|
|
chest pain possible ischemic heart |
1 |
1 |
|
|
chest pain probable ischemic heart |
2 |
4 |
|
ECG changes |
ischemic ST depressions |
2 |
3 |
|
|
infarct |
1 |
1 |
|
|
bundle branch block |
1 |
1 |
|
|
hypertrophy |
1 |
1 |
|
|
none of these |
0 |
0 |
|
age in years |
< 45 years |
0 |
0 |
|
|
45 to 65 years |
1 |
1 |
|
|
> 65 years |
2 |
1 |
|
number of risk factors and no history CAD |
0 |
0 |
0 |
|
|
1 or 2 |
1 |
0 |
|
|
3 to 6 |
2 |
1 |
|
number of risk factors and history CAD |
0 |
2 |
0 |
|
|
1 or 2 |
2 |
0 |
|
|
3 to 6 |
2 |
1 |
|
serum troponin |
less than cutoff (0.8 ng/mL) |
0 |
0 |
|
|
1 to 3 times cutoff |
1 |
2 |
|
|
> 3 times cutoff (> 2.4 ng/mL) |
2 |
5 |
where:
• The initial HEART score used 1 to 2 times the cutoff for troponin as 1 point.
• The cutoff for the troponin is the lowest cutoff value above the 99th percentile in which the assay imprecision is <= 10%.
º Obesity is a body mass index > 30 kg per square meter.
|
Parameter |
Finding |
Points |
|
sex |
female |
0 |
|
|
male |
1 |
|
serial ECG |
no change |
0 |
|
|
non diagnostic changes |
2 |
|
|
diagnostic changes |
5 |
|
serial change troponin at 2 hours |
< 0.1 ng/mL |
0 |
|
|
0.1 to 0.3 ng/mL |
2 |
|
|
> 0.3 ng/mL |
5 |
weighted HEART score =
= SUM(points for the HEART parameters)
HEARTS3 score =
= SUM(points for the HEART parameters) + SUM(points for the 3 additional parameters)
Interpretation:
• minimum score: 0
• maximum weighted HEART score: 14
• maximum HEARTS3 score: 25
• The higher the score the greater the risk that the chest pain represents ischemic heart disease.
• The higher the HEARTS3 score the greater the risk for 30-day acute coronary syndrome (ACS).
|
HEARTS3 Score |
AMI |
30-Day ACS |
|
0 or 1 |
0 |
0 |
|
2 |
0.5% |
1% |
|
3 |
0.5% |
5% |
|
4 |
2% |
10% |
|
5 |
4% |
16% |
|
6 or 7 |
19% |
36% |
|
8 or 9 |
47% |
60% |
|
10 to 12 |
72% |
78% |
|
13 or 14 |
87% |
89% |
|
15 to 25 |
100% |
100% |
Performance:
• The area under the ROC curve for AMI for the HEARTS3 is 0.96.
• The area under the ROC curve for 30-day acute coronary syndrome for the HEARTS3 is 0.90.
Purpose: To evaluate an adult in the Emergency Department with chest pain using the modified HEART and HEARTS3 scores of Fesmire et al.
Specialty: Cardiology
Objective: clinical diagnosis, including family history for genetics
ICD-10: R07,
