ArticleEuropean heart journal. Acute cardiovascular care2020
HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department.
Article in European heart journal. Acute cardiovascular care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Predictive Performance of the HEART Score for Acute Coronary Syndrome with Significant Coronary Stenosis in Patients with Non-ST-Elevation Acute Chest Pain.Journal of cardiovascular development and disease · 2026Article
- Diagnostic Accuracy Improvement of an Updated HEART Score to Predict Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography.Journal of clinical medicine · 2026Article
- Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department - 2025.Arquivos brasileiros de cardiologia · 2025Article
- Modification of the HEART pathway by adding coronary computed tomography angiography for patients suspected of acute coronary syndrome in the emergency department.Internal and emergency medicine · 2021Observational
- lncRNA-MALAT1 expression in patients with coronary atherosclerosis and its predictive value for in-stent restenosis.Experimental and therapeutic medicine · 2020Article
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8 authors.
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Abstract
aimsCoronary computed tomography angiography is increasingly employed in the emergency department for suspected acute coronary syndrome patients. The HEART score has been proposed for initial risk stratification in these patients. The aim of this study was to investigate the diagnostic value and efficiency of the HEART score before coronary computed tomography angiography. METHODS AND
resultsWe included patients suspected of acute coronary syndrome who underwent coronary computed tomography angiography in the emergency department. Based on the HEART score, patients were stratified as low-risk (HEART≤3), intermediate-risk (HEART4-6) and high-risk (HEART≥7). We assessed coronary computed tomography angiography for the presence of significant coronary artery disease (>50% stenosis). The primary outcome, the level of major adverse cardiac events, was a composite endpoint of all-cause mortality, acute coronary syndrome or coronary revascularisation within 30 days. The study population consisted of 340 patients (mean age: 55.6±10.1 years, 44.7% women), major adverse cardiac events occurred in 45 (13.2%) patients. The incidence of major adverse cardiac events in patients stratified as low-risk (35.0%), intermediate-risk (56.8%) and high-risk (8.2%) was 3.4%, 12.4% and 60.7%, respectively. All four low-risk patients with major adverse cardiac events had a HEART score of three. An algorithm where coronary computed tomography angiography is reserved for patients with HEART 3-6 resulted in a sensitivity of 97.8%, specificity of 84.1%, negative predictive value of 99.6% and positive predictive value of 48.4%, while reducing the need for coronary computed tomography angiography by 22% (
conclusionThe predictive value of coronary computed tomography angiography for 30-day major adverse cardiac events in suspected acute coronary syndrome patients is good, and reserving coronary computed tomography angiography for HEART score 3-6 patients reduces the number of needed coronary computed tomography angiograms without affecting diagnostic accuracy.
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