Article Sidebar

PDF (Tiếng Việt)
Published: 2026-03-31
Abstract Views: 0
Views PDF (Tiếng Việt): 0
DOI: https://doi.org/10.52852/tcncyh.v200i3.4858
Issue
Vol. 200 No. 3 (2026)
Section
Các bài báo
How to Cite
Trường, H. H., Ánh, B., & Sử, N. T. (2026). Association between the heart score and acute coronary syndrome in patients presenting with chest pain in the emergency department. Journal of Medical Research, 200(3), 82-94. https://doi.org/10.52852/tcncyh.v200i3.4858

Association between the heart score and acute coronary syndrome in patients presenting with chest pain in the emergency department

Hoang Huy Truong, Bui Anh, Nguyen Thanh Su

Main Article Content

Abstract

A cross-sectional study was conducted in 290 patients aged ≥ 18 years old presenting to the emergency department with chest or epigastric pain to evaluate the diagnostic value of the HEART score for acute coronary syndrome (ACS). The prevalence of ACS was 62.8% (182/290). Patients with ACS were older and had higher HEART scores compared with patients without ACS (median 6 [5 - 7] vs. 4 [3 - 5]; p < 0.001). The history, ECG, and troponin components differed significantly between the two groups, whereas age category and number of risk factors did not show significant differences. The proportion of ACS increased progressively with higher HEART scores and exceeded 90% at HEART ≥ 7. ROC analysis showed good discriminative ability for ACS by the HEART score, with an AUC of 0.872 (95% CI: 0.829 – 0.914; p < 0.001); at a cutoff > 4, the sensitivity was 89% and specificity 73.1%. In multivariable logistic regression, HEART > 4 was independently associated with ACS (OR = 23.91; 95% CI: 12.43 - 46.01; p < 0.001). The HEART score, particularly with a threshold > 4 points, may be a useful tool for identifying ACS among chest pain patients in the emergency department.

Article Details

Keywords

Acute coronary syndrome, chest pain, emergency department, HEART score, troponin

References

1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2021; 78(22): e187-e285. doi:10.1016/j.jacc.2021.07.053.
2. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023; 44(38): 3720-3826. doi:10.1093/eurheartj/ehad191.
3. Alexander Hirsch, Windhausen F, Tijssen JG, et al. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study. Lancet. 2007; 369(9564): 827-835. doi:10.1016/S0140-6736(07)60410-3.
4. Ramsay G, Podogrodzka M, Clure CMC, et al. Risk prediction in patients presenting with suspected cardiac pain: the GRACE and TIMI risk scores versus clinical evaluation. QJM An Int J Med. 2007; 100(1): 11-18. doi:10.1093/qjmed/hcl133.
5. Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Netherlands Hear J. 2008; 16(6): 191-196. doi:10.1007/BF03086144.
6. Backus BE, Six AJ, Kelder JC, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013; 168(3): 2153-2158. doi:10.1016/j.ijcard.2013.01.255.
7. Visser A, Wolthuis A, Breedveld R, et al. HEART score and clinical gestalt have similar diagnostic accuracy for diagnosing ACS in an unselected population of patients with chest pain presenting in the ED. Emerg Med J. 2015; 32(8): 595-600. doi:10.1136/emermed-2014-203798.
8. Han C, Chung H, Lee Y, et al. The predictive value of HEART score for acute coronary syndrome and significant coronary artery stenosis. Clin Exp Emerg Med. 2020; 7(4): 267-274. doi:10.15441/ceem.19.084.
9. Mahler SA, Riley RF, Hiestand BC, et al. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015; 8(2): 195-203. doi:10.1161/CIRCOUTCOMES.114.001384.
10. Nilsson T, Johannesson E, Forberg JL, et al. Diagnostic accuracy of the HEART Pathway and EDACS-ADP when combined with a 0-hour/1-hour hs-cTnT protocol for assessment of acute chest pain patients. Emerg Med J. 2021; 38(11): 808-813. doi:10.1136/emermed-2020-210833.
11. Park KT, Cho GC, Ryu JY, et al. The Usefulness of a Scoring System as a Predictor of Acute Coronary Syndrome in Chest Pain with an Unclear Diagnosis in the Emergency Department. J Korean Soc Emerg Med. 2013; 24(1): 55-62.
12. Trịnh Ngọc Duy, Bùi Thúc Quang. Mối liên quan giữa hội chứng mạch vành cấp và thang điểm HEART ở bệnh nhân cao tuổi đau ngực. Tạp chí Y học Việt Nam. 2023; 531(2): 126-130.
13. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019; 40(3): 237-269. doi:10.1093/eurheartj/ehy462.
14. Six AJ, Cullen L, Backus BE, et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol. 2013; 12(3): 121-126. doi:10.1097/HPC.0b013e31828b327e.