Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients
In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may...
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| Veröffentlicht in: | Internal and emergency medicine 2018-10, Vol.13 (7), p.1111-1119 |
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| creator | Moumneh, Thomas Richard-Jourjon, Vanessa Friou, Emilie Prunier, Fabrice Soulie-Chavignon, Caroline Choukroun, Jacques Mazet-Guilaumé, Betty Riou, Jérémie Penaloza, Andréa Roy, Pierre-Marie |
| description | In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0–1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0–0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay. |
| doi_str_mv | 10.1007/s11739-018-1803-4 |
| format | Article |
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A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0–1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0–0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.</description><identifier>ISSN: 1828-0447</identifier><identifier>EISSN: 1970-9366</identifier><identifier>DOI: 10.1007/s11739-018-1803-4</identifier><identifier>PMID: 29500619</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acute Coronary Syndrome - classification ; Acute Coronary Syndrome - diagnosis ; Acute coronary syndromes ; Angioplasty ; Biomarkers - analysis ; Biomarkers - blood ; Calcium-binding protein ; Chest ; Chest Pain - classification ; Chest Pain - diagnosis ; Electrocardiography ; Electrocardiography - methods ; EM - Original ; Emergency medical services ; Emergency Medicine - methods ; Emergency Medicine - trends ; Heart ; Heart diseases ; Heart surgery ; Humans ; Internal Medicine ; Medicine ; Medicine & Public Health ; Myocardial infarction ; Pain ; Population studies ; Prospective Studies ; Reproducibility of Results ; Risk Assessment - methods ; Risk Assessment - standards ; Severity of Illness Index ; Statistics ; Troponin ; Troponin - analysis ; Troponin - blood</subject><ispartof>Internal and emergency medicine, 2018-10, Vol.13 (7), p.1111-1119</ispartof><rights>SIMI 2018</rights><rights>Internal and Emergency Medicine is a copyright of Springer, (2018). All Rights Reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-cfad0d56cb58554b3609655d06ac636417a084e9f2e926f5b42bccebd66624823</citedby><cites>FETCH-LOGICAL-c406t-cfad0d56cb58554b3609655d06ac636417a084e9f2e926f5b42bccebd66624823</cites><orcidid>0000-0002-4229-9923 ; 0000-0002-7056-9257</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11739-018-1803-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11739-018-1803-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29500619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://univ-angers.hal.science/hal-02416142$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Moumneh, Thomas</creatorcontrib><creatorcontrib>Richard-Jourjon, Vanessa</creatorcontrib><creatorcontrib>Friou, Emilie</creatorcontrib><creatorcontrib>Prunier, Fabrice</creatorcontrib><creatorcontrib>Soulie-Chavignon, Caroline</creatorcontrib><creatorcontrib>Choukroun, Jacques</creatorcontrib><creatorcontrib>Mazet-Guilaumé, Betty</creatorcontrib><creatorcontrib>Riou, Jérémie</creatorcontrib><creatorcontrib>Penaloza, Andréa</creatorcontrib><creatorcontrib>Roy, Pierre-Marie</creatorcontrib><title>Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients</title><title>Internal and emergency medicine</title><addtitle>Intern Emerg Med</addtitle><addtitle>Intern Emerg Med</addtitle><description>In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0–1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0–0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.</description><subject>Acute Coronary Syndrome - classification</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute coronary syndromes</subject><subject>Angioplasty</subject><subject>Biomarkers - analysis</subject><subject>Biomarkers - blood</subject><subject>Calcium-binding protein</subject><subject>Chest</subject><subject>Chest Pain - classification</subject><subject>Chest Pain - diagnosis</subject><subject>Electrocardiography</subject><subject>Electrocardiography - methods</subject><subject>EM - Original</subject><subject>Emergency medical services</subject><subject>Emergency Medicine - methods</subject><subject>Emergency Medicine - trends</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial infarction</subject><subject>Pain</subject><subject>Population studies</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment - 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Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Internal and emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Moumneh, Thomas</au><au>Richard-Jourjon, Vanessa</au><au>Friou, Emilie</au><au>Prunier, Fabrice</au><au>Soulie-Chavignon, Caroline</au><au>Choukroun, Jacques</au><au>Mazet-Guilaumé, Betty</au><au>Riou, Jérémie</au><au>Penaloza, Andréa</au><au>Roy, Pierre-Marie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients</atitle><jtitle>Internal and emergency medicine</jtitle><stitle>Intern Emerg Med</stitle><addtitle>Intern Emerg Med</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>13</volume><issue>7</issue><spage>1111</spage><epage>1119</epage><pages>1111-1119</pages><issn>1828-0447</issn><eissn>1970-9366</eissn><abstract>In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0–1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0–0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>29500619</pmid><doi>10.1007/s11739-018-1803-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4229-9923</orcidid><orcidid>https://orcid.org/0000-0002-7056-9257</orcidid></addata></record> |
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| identifier | ISSN: 1828-0447 |
| ispartof | Internal and emergency medicine, 2018-10, Vol.13 (7), p.1111-1119 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Acute Coronary Syndrome - classification Acute Coronary Syndrome - diagnosis Acute coronary syndromes Angioplasty Biomarkers - analysis Biomarkers - blood Calcium-binding protein Chest Chest Pain - classification Chest Pain - diagnosis Electrocardiography Electrocardiography - methods EM - Original Emergency medical services Emergency Medicine - methods Emergency Medicine - trends Heart Heart diseases Heart surgery Humans Internal Medicine Medicine Medicine & Public Health Myocardial infarction Pain Population studies Prospective Studies Reproducibility of Results Risk Assessment - methods Risk Assessment - standards Severity of Illness Index Statistics Troponin Troponin - analysis Troponin - blood |
| title | Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients |
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