ArticleClinics (Sao Paulo, Brazil)2026
Chest pain in the emergency room: value of the new HEAR score identifying patients with low risk of acute coronary syndrome without troponin testing.
Article in Clinics (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChest pain is a frequent reason for Emergency Department (ED) visits, although only a minority of patients ultimately present an Acute Coronary Syndrome (ACS). Current diagnostic strategies rely heavily on troponin testing, but a new clinical tool requiring no blood sampling, the HEAR score, has recently been proposed. This study aimed to evaluate the performance of the HEAR score for identifying low-risk patients presenting with chest pain, using 45-day Major Adverse Cardiovascular Events (MACE) as the primary outcome.
methodsAll patients presenting with chest pain to the ED of Dijon University Hospital in 2019 were retrospectively analyzed in this single-center study. Patients were stratified as "low risk" (HEAR < 2) or "high risk" (HEAR ≥ 2). Outcomes assessed at 45-days included MACE (defined as a composite of all-cause death, non-fatal myocardial infarction, and urgent coronary revascularization) and recurrence of ED consultation for chest pain.
resultsAmong 2177 patients presenting with chest pain, 1807 met inclusion criteria. Of these, 653 (36%) were classified as low risk (HEAR < 2). At 45-days, 22 (3%) low-risk patients reconsulted for chest pain compared with 64 (6%) in the high-risk group (p = 0.037). No MACE was identified among low-risk patients within the available follow-up data. The negative predictive value of a HEAR score < 2 was 100% (95% CI: 99.5%-100%), with an upper 95% confidence bound for the event rate of 0.46%.
conclusionA HEAR score < 2 identifies a substantial proportion of ED chest pain patients at very low risk of short-term adverse cardiovascular events. However, given the limitations of retrospective follow-up and potential under-ascertainment of events, these findings should be considered hypothesis-generating. The HEAR score may contribute to early clinical risk stratification rather than replace troponin-based strategies.
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