BACKGROUND
The history, ECG, age, risk factors, and troponin (HEART) score was developed as a rapid risk stratification tool.1 It has five components (history, ECG, age, risk factors, and troponin), each assigned a score of 0, 1, or 2 points.2,3 Due to the wide spectrum of death risk and recurrent events among patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), management guidelines emphasise the importance of early risk stratification.4,5 This study aimed to determine whether the HEART score correlates with the angiographic extent and severity of coronary artery disease (CAD) in patients with NSTE-ACS.
METHODS
This was a cross-sectional observational study conducted in a tertiary care institute. Ethical clearance was taken. Among patients diagnosed with NSTE-ACS who underwent coronary angiography during index hospitalisation, 92 patients were included using consecutive sampling, following the inclusion and exclusion criteria. Evaluations of patients included history, clinical examination, and data collection using a semi-structured questionnaire. Patients were divided into two groups; Group I: low HEART Score (0–6), and Group II: high HEART Score (7–10). Coronary angiogram was performed, and the severity was assessed by the SYNTAX™ (Boston Scientific Way, Marlborough, Massachusetts, USA) score. All coronary lesions with diameter stenosis >50% in vessels with a >1.5 mm diameterwere recorded. For the statistical methods, quantitative data were expressed as mean and standard deviation, and compared using the Student’s t-test. Qualitative data were expressed as frequency and percentage, and compared using the Chi-square test. Logistic regression analysis was performed, and a p value <0.050 was considered statistically significant.
RESULTS
Comparison of the study group according to the lesion severity (N=92) showed that triple vessel disease and left main disease were more prevalent in Group II (high HEART score) than Group I (low HEART score). Conversely, single vessel disease and normal/non-critical CAD were observed more in Group I. These differences were statistically significant (p<0.001).
Comparison of the study group according to the SYNTAX score (N=92) showed that a low SYNTAX score was observed in patients with a low HEART score (Group I) compared to Group II (97.8% versus 69.6%). Conversely, a high SYNTAX score was observed in patients with a high HEART score (30.4% versus 2.2%). These differences were statistically significant (p<0.001). Again, the median SYNTAX score was significantly higher in Group II compared to Group I (20.0 versus 6.50; p<0.001).
Correlation between the HEART score and SYNTAX score showed that a positive correlation (p=0.665) was observed, which was statistically significant (p<0.001). This suggests that the higher the HEART score, the higher the SYNTAX score.
The receiver operating characteristic (ROC) curve was used for detecting severe coronary artery stenosis. Using the SYNTAX score, the ROC curve showed that a cut-off value of HEART Score 7 had a sensitivity of 80.0%, and specificity of 72.7%, in predicting the severity of CAD. The area under the ROC curve was statistically significant. Multivariate logistic regression analysis to measure predictors of severe CAD revealed that the HEART score was an independent predictor for the development of severe CAD (odds ratio: 1.767; 95% CI: 1.023–3.051; p=0.040).
CONCLUSION
This study demonstrates that the HEART score has a significant positive correlation with the severity of CAD in patients with NSTE-ACS.
