Risk Scores for Major Cardiac Events
Not a single clinical shift passes without evaluation of at least one patient with chest pain - Thomas del Ninno MD
HWN Suggests
MDCalc Wars: HEART Score Vs. EDACS
Both HEART and EDACS are best utilized for identifying patients with suspected ACS who are at low risk for MACE. HEART Score is specifically designed for patients presenting with chest pain, whereas EDACS can be applied to a broader patient population with various symptoms suspicious for ACS, including those with chest pain. Both HEART Pathway and EDACS-ADP can be applied using high-sensitivity troponin, resulting in a decreased number of low risk patients and rate of MACE.
Featured
Are we Missing Acute MIs with Clinical Risk Scores?
Clinical gestalt remains the most useful tool for assessment of risk of ACS/AMI. The use of risk assessment tools should be regarded as just that, tools. Keep in mind the limitations of each as you are taking care of patients.
Articles of Interest
Chest Pain Scores
Summary of the different scores to identify low risk patients.
HEART vs EDACS Scores on Predicting Major Events Among Patients With Suspected Acute Coronary Syndrome
This study concludes that HEART score has better sensitivity than EDACS in predicting MACE among suspected ACS patients at the cardiac ED.
New tool helps emergency medicine physicians provide more personalized care to patients with chest pain
The study found that both the RISTRA-ACS and the HEART pathway risk scores accurately identified very low-risk patients. However, the RISTRA-ACS risk score was found to be better than the HEART score, troponin tests alone, and physician judgement in distinguishing which patients would experience a major heart problem within 60 days. In addition, the RISTRA-ACS tool accurately risk stratified more than 50% of the patients with only a single troponin measurement, whereas the EDACS-ADP and HEART pathway require multiple troponin tests.
Risk Scores for Clinical Risk Stratification of Emergency Department Patients With Chest Pain but No Acute Myocardial Infarction: A Systematic Review
The HEART score with a cutoff value of 3 or less accurately identified the greatest number of patients at low risk of 30-day MACE. However, MACE risk among patients who have MI ruled out by means of high-sensitivity troponin testing is sufficiently low that clinical risk stratification or noninvasive testing may be of little additional value in identifying patients with coronary disease.
Resources
HEART Pathway
Identifies emergency department patients with acute chest pain for early discharge.
EDACS (Emergency Department Assessment of Chest Pain Score}
Identifies chest pain patients with low risk of major adverse cardiac event. This score only applies to patients: (1) ≥18 years old with normal vital signs; (2) Chest pain consistent with ACS; (3) No ongoing chest pain or crescendo angina.
HEART Score
Predicts 6-week risk of major adverse cardiac event. Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.
Vancouver Chest Pain Rule
e. The Vancouver Chest Pain Rule identifies low-risk chest pain patients who can be safely discharged from the ED after the standard initial evaluation of history and physical examination, ECG, and 1 cardiac biomarker (usual-sensitivity troponin).
TIMI Risk Score for STEMI
Estimates mortality in patients with STEMI.
TIMI Risk Score for UA/NSTEMI
Estimates mortality for patients with unstable angina and non-ST elevation MI.
