Heart Score for Predicting in Hospital Major Cardiovascular Event in Patient with Non ST Segment Elevation Acute Coronary Syndrome

Abstract

Background: Acute Coronary Syndrome (ACS) is one of the main problems in the field of cardiovascular diseases because of high hospitalization rate, high mortality and high medical cost. Rapid and accurate risk stratification is needed to calculate the risk of complication and right now exist two most used score which is GRACE and TIMI. Heart score has 5 simple variables that can be calculated easily and this score considered to have better predictive ability compared to other score. The aim of this study is to examine HEART score as a predictor for in hospital Major Cardiovascular Event (MACE) in patient diagnosed as Non ST Segment Elevation Acute Coronary Syndrome (NSTEACS) that hospitalized at Haji Adam Malik (HAM) General Hospital Medan.

Methods: This is a prospective cohort study that includes 52 NSTEACS patient that hospitalized at HAM General Hospital since November 2018 until January 2019. Patient that diagnosed as NSTEACS were calculated for GRACE, TIMI, and HEART score then observed during hospitalization. Outcome of this study is MACE during hospitalization. Statistical analysis was performed to test HEART score as MACE predictor and then comparison was done with GRACE and TIMI

Results: By using ROC curve analysis, the cut-off value of HEART score was 5 (AUC 0.947, 95% CI 0.883-0.997, p<0.01). Study subject that experienced MACE with HEART score ≥5 was 21 patients (87.5%) compared to 2 patients (7.1%). HEART score ≥5 can predict MACE with sensitivity 87.5%, specificity 92.9%, negative predictive value (NPV) 89.7% and positive predictive value (PPV) 91.3%. ROC curve comparison was done between HEART with GRACE and TIMI then it was found that HEART score has better predictive ability compared to TIMI and GRACE (AUC 0.947 vs 0.829 vs 0.807, p < 0.01).

Conclusion: HEART score can be used as MACE predictor which is relatively simpler but have better predictive ability compared to GRACE and TIMI.