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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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Moumneh, Thomas Richard-Jourjon, Vanessa Friou, Emilie Prunier, Fabrice Soulie-Chavignon, Caroline Penaloza-Baeza, Andrea [UCL] Roy, Pierre-Marie

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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2018
Language Anglais
Journal information "Internal and Emergency Medicine" - Vol. 13, no.7, p. 1111-1119 (2018)
Peer reviewed yes
Publisher Springer Italia Srl ((Italy) Milano)
issn 1828-0447
e-issn 1970-9366
Publication status Publié
Affiliations UCL - SSS/IREC/EPID - Pôle d'épidémiologie et biostatistique
UCL - (SLuc) Service des urgences
MESH Subject Acute Coronary Syndrome ; Biomarkers ; Chest Pain ; Electrocardiography ; Emergency Medicine ; Humans ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Severity of Illness Index ; Troponin
Keywords Acute coronary syndrome ; Chest pain ; Major adverse cardiac event ; Risk assessment
Links
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Bibliographic reference Moumneh, Thomas ; Richard-Jourjon, Vanessa ; Friou, Emilie ; Prunier, Fabrice ; Soulie-Chavignon, Caroline ; et. al. Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients.. In: Internal and Emergency Medicine, Vol. 13, no.7, p. 1111-1119 (2018)
Permanent URL http://hdl.handle.net/2078.1/221285