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.
JC Supervisor: Dr. Krishan Yadav