Methodology: 3/5
Usefulness: 3/5

O’Rielly CM, et al. Can J Cardiol. 2023 Mar;39(3):304-310. doi: 10.1016/j.cjca.2022.12.028. 

Question and Methods: The authors conducted a systematic review to identify and synthesize prognostic performance of chest pain risk scores amongst patients with negative primary ACS events, as defined by high sensitivity troponin assays.
Findings: Primary results demonstrated that a HEART score, with a cutoff of three or less, predicted a very low risk of 30-day MACE amongst the greatest proportion of patients. Both the HEART Score and TIMI score demonstrated sensitivities of more than 96% for 30-day MACE events.
Limitations: One of the big limitations of this study was the fact that it did not address the use of high sensitivity troponin algorithms as a possible viable alternative. Furthermore, the high risk or unknown risk of bias for 50% of the studies included, make the results difficult to interpret. Especially in the context of lack of data to perform a meta-analysis.

Interpretation: This paper further emphasized that the HEART score can be used to identify low-risk patients for risk of MACE at 30d. However, with the advent of hs-TnT with similar 30d-MACE event risks of 1-2%, the utility of such a score is questionable.

Dr.  Josee Malette

JC Supervisor: Dr. Krishan Yadav




  • Josee Malette

    Dr. Josée Malette is an Emergency Medicine Resident in the Department of Emergency Medicine, University of Ottawa. She is a Senior Editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog. Her interests involve critical care in low resource settings, medical education, rural medicine and prehospital medicine.

  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

  • Krishan Yadav

    Dr. Krishan Yadav is an FRCPC Emergency Medicine Physician, and Epidemiologist with a special interest in non-purulent skin and soft tissue infectious disease.