The HEART score as a prognostic tool for revascularization: comment
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CE - LETTER TO THE EDITOR
The HEART score as a prognostic tool for revascularization: comment Yo Sep Shin1 · Shin Ahn1 Received: 17 November 2019 / Accepted: 21 November 2019 © Società Italiana di Medicina Interna (SIMI) 2019
Dear Editor, We read with great interest, the recent article by Oliver et al. [1] published in the journal. Through our letter, we aim to discuss additional findings and discrepancies with regard to the HEART score in a different setting. The researchers investigated the HEART score’s ability to identify a patient’s need for revascularization including percutaneous coronary intervention (PCI) with stents and coronary artery bypass graft (CABG). They have included all subjects who pre‑ sented at the emergency department (ED) with chest pain. They did not include chest pain equivalents such as short‑ ness of breath unless the chief complaint “chest pain” was included along with the related complaint. The area under the receiver operator curve was 0.877 [95% confidence inter‑ val (CI) 0.806–0.949] for the HEART score’s ability to pre‑ dict PCI and 0.921 (95% CI 0.858–0.984) for CABG, show‑ ing strong association between the HEART score and need for revascularization. However, in real practice, even though the patients do not present with chest pain, sometimes they are considered as having anginal symptoms—presence of coronary artery disease. Symptoms such as dyspnea, dia‑ phoresis, and pain radiating to jaw, neck, shoulder, and arm are so called anginal equivalents and they can present with or without chest pain in patients with coronary artery disease [2]. Accurate diagnosis of coronary artery disease within patients with anginal equivalents is still challenging for ED physicians. The challenges have caused practitioners to miss early diagnosis of acute coronary syndrome and sometimes leads to catastrophic events, such as cardiac arrest; patients presenting with only dyspnea of cardiac origin are reported to have a twofold increased risk for sudden death [3]. We recently performed a study regarding risk stratification of patients with chest pain or anginal equivalents in the ED * Shin Ahn [email protected] 1
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic‑ro 43‑gil, Songpa‑gu, Seoul 05505, Korea
[4]. We retrospectively collected data from January 2017 to December 2018 for all consecutive adult patients who presented with either chest pain or anginal equivalents in the ED. Only patients who underwent coronary computed tomographic angiography during their stay in the ED were included. We considered symptoms such as dyspnea, epigas‑ tric pain, diaphoresis, or palpitation as anginal equivalents if patients who presented with these symptoms had undergone computed tomographic angiography during their stay in the ED. Among our study population of 1247 patients, the pri‑ mary outcome, MACE within 30 days, occurred in a total of 200 patients (16.0%); of them, 158 (79%) underwent PCI, and 18 (9%) underwent CABG surgery. The area under the r
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