• IoannidesKimon L HKLHhttps://orcid.org/0000-0002-6384-2235National Clinician Scholars Program Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA., Benjamin C Sun, Aileen S Baecker, Rita F Redberg, Ming-Sum Lee, Maros Ferencik, Yi-Lin Wu, Ernest Shen, Chengyi Zheng, Visanee Musigdilok, Stacy J Park, and Adam L Sharp.
• National Clinician Scholars Program Department of Emergency Medicine University of California, Los Angeles Los Angeles California USA.
• J Am Coll Emerg Physicians Open. 2020 Dec 1; 1 (6): 1161-1167.

ObjectiveWe sought to identify sub-groups of "low-risk" HEART score patients (history, ECG, age, risk factors, and troponin) at elevated risk of acute myocardial infarction or death within 30 days.MethodsWe performed a secondary analysis of prospective emergency department (ED) encounters for suspected acute coronary syndrome in a large health system with low-risk HEART scores (0-5 points). Logistic regression using the 5 components of the HEART score analyzed the increase risk attributable to points from each of the 5 score components.ResultsOf 30,971 encounters among 28,992 unique patients, 135 (0.44%, 95% confidence interval [CI] = 0.37-0.51) experienced acute myocardial infarction or death. Risk increased for each component of the HEART score from 0 to 1 to 2 points (history, 0.4% to 0.5% to 0.6%; ECG, 0.3% to 0.7% to 0.7%; age, 0.2% to 0.3% to 0.7%; risk factors, 0.1% to 0.4% to 0.8%), except troponin, which had the highest risk with 1 point (troponin, 0.4% to 2.7% to 0.9%). Odds ratios from our regression, which adjusts for other components, showed a similar pattern (from 1 vs 0 and 2 vs 0 points, respectively: history, 1.0 and 1.8; ECG, 2.2 and 3.5; age, 1.2 and 2.1; risk factors, 2.4 and 4.2; and troponin, 6.0 and 3.6).ConclusionAmong "low-risk" suspected acute coronary syndrome encounters, increasing points within each of the 5 categories demonstrated small increases in risk of death or acute myocardial infarction, with the troponin and ECG components representing the largest risk increases.© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

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