Observational studyInternal and emergency medicine2021
Modification of the HEART pathway by adding coronary computed tomography angiography for patients suspected of acute coronary syndrome in the emergency department.
Observational study in Internal and emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.
- A meta-analysis on the safety and accuracy of the HEART pathway for risk stratification in patients with acute chest pain.BMC cardiovascular disorders · 2025Pooled it
- Computed tomography coronary angiography after excluding myocardial infarction: high-sensitivity troponin versus risk score-guided approach.World journal of emergency medicine · 2023Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The HEART (history, ECG, age, risk factors, troponin) pathway (HP) was developed for identifying low-risk patients for early discharge among patients presenting with chest pain to the emergency department (ED). We investigated whether adding coronary computed tomography angiography (CCTA) results to selected patients could improve the diagnostic accuracy of the HP. Patients suspected of acute coronary syndrome who had undergone CCTA were included. The HP was modified by adding CCTA results of stenosis of any major epicardial coronary arteries to patients either with 0-3 points and a positive troponin test or with 4-6 points. All patients were reclassified into low and increased risk groups. We then compared the accuracy of the modified HP, the HP, and the HEART score. The primary outcome was the 30-day major adverse cardiac events (MACE). Of the total 1239 patients included, MACE occurred in 206 (16.6%) patients. Adding the CCTA results increased the proportion of patients with low risk (68.7%) compared with the HP (40.0%) and the HEART score (47.4%). Using the modified HP, 50.4% of patients with intermediate-risk by the HEART score could be discharged from the ED and had no MACE. Incorporation of CCTA results improved the accuracy rate for the prediction of MACE compared with the HP and the HEART score (net reclassification improvements were 34.5 and 39.6%, respectively). Using the CCTA after the HP in selected patients could be a better strategy to discharge more patients early and safely.
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Registered trials
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