• Ziad Faramand, Christian Martin-Gill, Stephanie O Frisch, Clifton Callaway, and Salah Al-Zaiti.
• Department of Acute & Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, PA, USA; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. Electronic address: zif10@pitt.edu.
• Am J Emerg Med. 2021 Jul 1; 45: 303-308.

IntroductionHEART score is widely used to stratify patients with chest pain in the emergency department but has never been validated for cocaine-associated chest pain (CACP). We sought to evaluate the performance of HEART score in risk stratifying patients with CACP compared to an age- and sex-matched cohort with non-CACP.MethodsThe parent study was an observational cohort study that enrolled consecutive patients with chest pain. We identified patients with CACP and age/sex matched them to patients with non-CACP in 1:2 fashion. HEART score was calculated retrospectively from charts. The primary outcome was major adverse cardiac events (MACE) within 30 days of indexed encounter.ResultsWe included 156 patients with CACP and 312 age-and sex-matched patients with non-CACP (n = 468, mean age 51 ± 9, 22% females). There was no difference in rate of MACE between the groups (17.9% vs. 15.7%, p = 0.54). Compared to the non-CACP group, the HEART score had lower classification performance in those with CACP (AUC = 0.68 [0.56-0.80] vs. 0.84 [0.78-0.90], p = 0.022). In CACP group, Troponin score had the highest discriminatory value (AUC = 0.72 [0.60-0.85]) and Risk factors score had the lowest (AUC = 0.47 [0.34-0.59]). In patients deemed low-risk by the HEART score, those with CACP were more likely to experience MACE (14% vs. 4%, OR = 3.7 [1.3-10.7], p = 0.016).ConclusionIn patients with CACP, HEART score performs poorly in stratifying risk and is not recommended as a rule out tool to identify those at low risk of MACE.Copyright © 2020 Elsevier Inc. All rights reserved.

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