Integrating male gender, right bundle branch block, hemoglobin, and glucose into the HEART score improved the AUC for predicting significant coronary stenosis from 0.68 to 0.74 (p=0.004).
Observational (n=379)
Does an updated HEART score integrating additional clinical variables improve diagnostic accuracy for predicting significant coronary artery stenosis on CCTA in patients with suspected ACS?
Adding male gender, right bundle branch block, hemoglobin, and glucose levels to the HEART score significantly improves its diagnostic accuracy and risk reclassification for detecting ≥70% coronary stenosis on CCTA in suspected ACS patients.
Effect estimate: NRI 13.5%
Absolute Event Rate: 0.74% vs 0.68%
p-value: p=0.004
Background: The HEART score is a widely used risk-stratification tool in suspected acute coronary syndrome (ACS), but it still suffers from several limitations. We aim to assess its diagnostic accuracy for predicting coronary computed tomography angiography (CCTA) findings and explore possible enhancement by integrating additional clinical variables. Methods: In this retrospective, observational study, consecutive patients presenting to the Emergency Department with suspected ACS and undergoing CCTA were analyzed. The study assessed the HEART score’s diagnostic accuracy for predicting significant coronary artery stenosis (defined as ≥70% stenosis at CCTA) and explored improvements by integrating additional clinical variables for low-to-moderate-risk patients. Results: Three hundred seventy-nine patients were enrolled (age: 61 ± 15 years; male: 57%). According to the HEART score, 27% were at low risk, 67% moderate risk, and 6% high risk, with a prevalence of significant CAD of 7%, 27%, and 67%, respectively. The area under the curve (AUC) of the HEART score to predict significant CAD was 0.68. Male gender (OR = 1.76, 95% CI 1.03–3.02), right bundle branch block (OR = 4.15, 95% CI 1.66–10.40), and hemoglobin (OR = 1.21) and glucose levels (OR = 1.01) independently predicted significant coronary stenosis at CCTA in patients at low-to-moderate risk. Integrating these variables into the HEART score, the AUC improved from 0.68 to 0.74 (p = 0.004), with a net reclassification improvement of 13.5% (p = 0.032). Conclusions: Integrating additional clinical variables into the HEART score improves its accuracy to predict significant coronary artery stenosis at CCTA in suspected ACS patients at low-to-moderate risk. Tailoring assessments with these variables supports more accurate patient management and highlights the potential for more comprehensive diagnostic approaches.
Rocca et al. (Wed,) conducted a observational in Suspected acute coronary syndrome (ACS) (n=379). Updated HEART score (integrating male gender, RBBB, hemoglobin, and glucose) vs. Standard HEART score was evaluated on Significant coronary artery stenosis (≥70% stenosis at CCTA) (NRI 13.5%, p=0.004). Integrating male gender, right bundle branch block, hemoglobin, and glucose into the HEART score improved the AUC for predicting significant coronary stenosis from 0.68 to 0.74 (p=0.004).
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