The following is a summary of “HEART-score can be simplified without loss of discriminatory power in patients with chest pain – Introducing the HET-score,” published in the December 2023 issue of Emergency Medicine by Löfmark, et al.

For a study, researchers sought to validate the effectiveness of a simplified scoring system, termed the History, Electrocardiogram, and Troponin (HET-score), in stratifying the risk of cardiovascular events in patients with chest pain, in comparison to the established History, Electrocardiogram, Age, Risk factors, and Troponin (HEART) score.

Patients presenting with chest pain lasting at least 10 minutes and occurring within the past 12 hours, without ST-segment elevation on ECG, were recruited from six emergency departments. Both the HEART-score and the simplified HET-score were calculated for each patient. The primary endpoint was a composite of myocardial infarction (MI) as the index diagnosis, readmission due to new MI, or death within 30 days. Multivariable logistic regression analysis assessed the association between variables included in the scores and cardiovascular events.

The HEART-score categorized patients into low (0-2 points), intermediate (3-5 points), and high-risk (6-10 points) groups, with corresponding endpoint occurrence rates of 0.5%, 7.3%, and 35.7%, respectively. Conversely, the HET-score classified patients into low (0 points), intermediate (1-2 points), and high-risk (3-6 points) categories, with endpoint incidence rates of 0.6%, 6.2%, and 43.2%, respectively. Multivariable analysis revealed that History (odds ratio [OR]: 2.97; 95% CI: 2.16–4.09), ECG (OR: 1.61; CI: 1.14–2.28), and troponin level (OR: 5.21; CI: 3.91–6.95) were significantly associated with cardiovascular events. Additionally, the HET-score demonstrated a significantly larger area under the curve (AUC) in the receiver operating characteristic (ROC) analysis compared to the HEART-score (0.887 vs. 0.853, P < 0.001).

The simplified HET-score presented a comparable ability to the HEART-score in risk stratification of chest pain patients for cardiovascular events. It is a simpler alternative that may offer similar efficacy in identifying patients at risk of myocardial infarction, readmission, or death within 30 days.

Reference: sciencedirect.com/science/article/pii/S0735675723005119