External Validation of the HEART Score for Predicting Major Adverse Cardiac events in Patients with Chest Pain in emergency department

Background Coronary pathology is one of the most life-threatening causes of chest pain. A well-coded diagnosis and prognosis approach is essential. The HEART score is a valuable tool for predicting the occurrence of major adverse cardiac events (MACE) at one month. This study aimed to evaluate the prognostic value of the HEART score among patients with acute chest pain in a Tunisian emergency department (ED). Methods This was a prospective observational study conducted over a 13-month period (August 2022 - August 2023) in the ED of the Mahmoud El Matri regional hospital. We included 588 patients over 18 years of age who presented to the ED for acute non-traumatic chest pain. Epidemiological, clinical, biological, and therapeutic characteristics were recorded, and HEART scores were calculated. The primary endpoint was the occurrence of MACE at one month. Results The mean age of the 588 patients was 54 ± 15 years, with a slight male predominance (sex ratio 1.15). The main cardiovascular risk factors were hypertension (36.1%) and diabetes (30.6%). At one-month follow-up, seven patients (1.2%) experienced a MACE. The mean HEART score was 2.5 ± 1.59. The HEART score had an excellent discriminatory power, with an area under the ROC curve of 0.981 (95% CI [0.963; 0.999]; p < 0.001). For a threshold value of 4.5, its sensitivity, specificity, and negative predictive value were 100%, 89%, and 100%, respectively. Conclusion The HEART score is an effective tool for identifying patients at low risk of ischemia, allowing them to be safely discharged from the ED without further investigations. These findings support its implementation in our clinical setting, though validation on a larger scale is warranted.