Pre-hospital HEART score assessment classified 26% of suspected NSTE-ACS patients as low risk, but yielded a 30-day MACE rate of 4.7%, exceeding the 2% safety threshold for early discharge.
Observational
Single-blind
Yes
Does the pre-hospital HEART score accurately identify low-risk patients with suspected non-ST-elevation acute coronary syndrome compared to in-hospital assessment?
Patients with suspected non-ST-elevation acute coronary syndrome in pre-hospital settings
HEART Score assessment in pre-hospital settings
HEART Score assessment in in-hospital settings
Agreement between pre- and in-hospital HEART scores and 30-day MACE ratecomposite
The pre-hospital HEART score showed moderate agreement with in-hospital scores, but a 4.7% 30-day MACE rate in the low-risk group suggests the need for improved training and high-sensitivity assays before it can be safely used to rule out ACS pre-hospital.
Pre- and in-hospital HEART scores showed moderate agreement. The 30-day MACE rate (4.7%) in the pre-hospital low-risk group indicates that improved training in history and ECG assessment, and use of high-sensitivity assays are required.
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Jaouad Azzahhafi
Dean R.P.P. Chan Pin Yin
Mirjam T. Epping
Netherlands Heart Journal
University Medical Center Utrecht
Maastricht University Medical Centre
St. Antonius Ziekenhuis
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Azzahhafi et al. (Mon,) conducted a observational in Suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=331). Pre-hospital HEART score with point-of-care conventional troponin I vs. In-hospital HEART score with ESC 0/1-hour high-sensitivity troponin T algorithm was evaluated on Sensitivity for major adverse cardiac events (MACE) at 30 days (AUC 0.72, 95% CI 0.64-0.81, p=<0.001). Pre-hospital HEART score assessment classified 26% of suspected NSTE-ACS patients as low risk, but yielded a 30-day MACE rate of 4.7%, exceeding the 2% safety threshold for early discharge.
www.synapsesocial.com/papers/69df2a4be4eeef8a2a6af722 — DOI: https://doi.org/10.1007/s12471-026-02041-x