Author + information
- James Kogut,
- Mehrdad Ghahramani,
- Matthew Nudy,
- Ian Gilchrist,
- Brandon Peterson and
- Andrew Foy
Background: Chest pain and other symptoms concerning for acute coronary syndrome (ACS) are the leading causes of adult emergency department (ED) visits in the United States each year. Previously, the HEART score has been found to be useful in risk stratifying patients for a major adverse cardiac event (MACE) but its effect on the predictive accuracy of stress testing has not been investigated.
Methods: We retrospectively reviewed emergency medical record data for patients without a history of CAD admitted to the ED Observation Unit who underwent stress echocardiography from 2013 to 2015, and assigned each patient a HEART score. The positive predictive value (PPV) of stress echocardiography and overall rate of obstructive CAD detection were compared between patients based on their HEART score category (low [0-3] vs. high [4+]).
Results: In 1,021 patients who underwent stress echocardiography, 2% were found to have obstructive CAD on cardiac catheterization. 81% of patients were classified as low risk and 19% as high risk. There was not a significant difference in the PPV of stress echocardiography between patients classified as low vs. high risk (26% vs. 30%; p = 0.7582) but there was a significant difference in the detection of obstructive CAD (1% vs. 4%; p = 0.0082).
Conclusions: While the HEART score was not associated with a significant improvement in the predictive accuracy of stress echocardiography in this single-center ED observation unit cohort, the HEART score category did influence the overall detection rate of obstructive CAD. The results of our study, while limited by the overall low detection rate of CAD, are intriguing and may be useful for shared decision making when determining if stress testing is warranted in an ED observation unit setting.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Applications of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1160-224
- 2017 American College of Cardiology Foundation