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Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score.

Leite L, Baptista R, Leitão J, Cochicho J, Breda F, Elvas L, Fonseca I, Carvalho A, Costa JN - BMC Cardiovasc Disord (2015)

Bottom Line: Male gender, smoking and chronic kidney disease were associated with higher risk of ACS.The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001).The HEART score seems to be an effective tool for risk stratification in the ED.

View Article: PubMed Central - PubMed

Affiliation: Departament of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, 3000-075, Portugal. luispcleite@gmail.com.

ABSTRACT

Background: Fast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories. We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess the prognostic value of Manchester triage system and of HEART score.

Methods: Retrospective observational study including patients admitted to the ED of a tertiary hospital with chest pain as the presenting symptom. The primary outcome was a composite of all-cause mortality, myocardial infarction or unscheduled revascularization at 6 weeks.

Results: We enrolled 233 patients (age 58 ± 19; 55.4 % males). The most common final diagnosis was non-specific chest pain (n = 86, 36.9 %), followed by ACS (n = 22, 9.4 %). Male gender, smoking and chronic kidney disease were associated with higher risk of ACS. According to Manchester triage system, chest pain patients stratified with red or orange priority had a higher incidence of ACS (16.5 % vs. 3.8 %, p = 0.006). The application of HEART score showed that most patients were in low risk category (56.3 %). The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001). HEART score accurately predicted the short-term incidence of MACE in chest pain patients (c-statistic 0.880; 95 % CI, 0.807-0.950, p < 0.001).

Conclusions: Chest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

No MeSH data available.


Related in: MedlinePlus

Incidence of 6-week MACE in each HEART score. MACE, major adverse cardiovascular events
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Related In: Results  -  Collection

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Fig3: Incidence of 6-week MACE in each HEART score. MACE, major adverse cardiovascular events

Mentions: Figure 3 illustrates the relationship between the HEART score and the incidence of the composite endpoint, with higher scores associated with higher incidence of 6-week MACE.Figure 3


Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score.

Leite L, Baptista R, Leitão J, Cochicho J, Breda F, Elvas L, Fonseca I, Carvalho A, Costa JN - BMC Cardiovasc Disord (2015)

Incidence of 6-week MACE in each HEART score. MACE, major adverse cardiovascular events
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4462114&req=5

Fig3: Incidence of 6-week MACE in each HEART score. MACE, major adverse cardiovascular events
Mentions: Figure 3 illustrates the relationship between the HEART score and the incidence of the composite endpoint, with higher scores associated with higher incidence of 6-week MACE.Figure 3

Bottom Line: Male gender, smoking and chronic kidney disease were associated with higher risk of ACS.The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001).The HEART score seems to be an effective tool for risk stratification in the ED.

View Article: PubMed Central - PubMed

Affiliation: Departament of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, 3000-075, Portugal. luispcleite@gmail.com.

ABSTRACT

Background: Fast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories. We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess the prognostic value of Manchester triage system and of HEART score.

Methods: Retrospective observational study including patients admitted to the ED of a tertiary hospital with chest pain as the presenting symptom. The primary outcome was a composite of all-cause mortality, myocardial infarction or unscheduled revascularization at 6 weeks.

Results: We enrolled 233 patients (age 58 ± 19; 55.4 % males). The most common final diagnosis was non-specific chest pain (n = 86, 36.9 %), followed by ACS (n = 22, 9.4 %). Male gender, smoking and chronic kidney disease were associated with higher risk of ACS. According to Manchester triage system, chest pain patients stratified with red or orange priority had a higher incidence of ACS (16.5 % vs. 3.8 %, p = 0.006). The application of HEART score showed that most patients were in low risk category (56.3 %). The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001). HEART score accurately predicted the short-term incidence of MACE in chest pain patients (c-statistic 0.880; 95 % CI, 0.807-0.950, p < 0.001).

Conclusions: Chest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

No MeSH data available.


Related in: MedlinePlus