48The pre-hospital HEART score is a strong predictor of MACE in patients with suspected non-STEMI

Abstract

Background: Triage of patients with chest pain usually occurs in the hospital emergency room (ER). It has been shown that the HEART-score offers a simple and quick risk-stratification tool for these patients. Additionally the high-sensitive Troponin T (hs-cTnT) provides a great diagnostic accuracy and detection of acute myocardial infarction. Purpose: This study investigated whether a pre-hospital chest pain triage is feasible in terms of early ruling out acute coronary syndrome (ACS) in the ambulance by ambulance nurses using a single hs-cTnT measurement as to establish the HEART-score. Methods: This is the first, exploratory phase, of two prospective, nonrandomized, observational cohort studies, prior to additional training of ambulance nurses. Patients with acute onset chest pain were prospectively evaluated at first medical contact by ambulance nurses including the HEART-score and a hs-cTnT assessment. Follow-up was performed at 30 days in terms of MACE. Results: A pre-hospital HEART-score was determined in 600 chest pain patients without ST-segment elevation. Mean age was 70 years, 38% was female. 140 Patients (23.3%) were classified as low risk, 341 (56.8%) as intermediate and 119 (19.8%) as high risk patients. This corresponded with a significant (p = <0.001) difference in MACE within 30 days of 2.9%; 18.8% and 45.4%, respectively. Also, the pre-hospital HEART-score was a strong predictor of the individual factors of MACE: ACS (p = <0.001), PCI (p=0.001), CABG (p<0.001), death (p=0.02). There were no deaths in the low risk group. Conclusion: The HEART-score, especially for the low risk group, has a clear negative predictive value for MACE. Pre-hospital chest pain triage using the HEARTscore in combination with hs-cTnT measurement provides an excellent tool in identifying low risk on MACE and might help in optimizing logistics and costeffectiveness for this patient population prior to hospital admission.