Clinically relevant adverse cardiovascular events in intermediate heart score patients admitted to the hospital following a negative emergency department evaluation

• Published in: The American journal of emergency medicine Vol. 46; pp. 469 - 475
• Main Authors: Spiegel, Rory, Sutherland, Mark, Brown, Robert, Honasoge, Akilesh, Witting, Michael
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.08.2021; Elsevier Limited
• Subjects: Acute coronary syndrome; Acute coronary syndromes; Calcium-binding protein; Cardiac arrhythmia; Cardiac catheterization; Cardiovascular disease; Catheterization; Coronary vessels; EKG; Electronic health records; Emergency; Emergency medical care; Emergency medical services; Heart attacks; Heart surgery; Implants; Intubation; Medical imaging; Pain; Patients; Physicians; The HEART score; Troponin; United States > US; Acute coronary syndrome; The HEART score
• DOI: 10.1016/j.ajem.2020.10.065
• ISSN: 0735-6757; 1532-8171

Study objective: To estimate the frequency of clinically relevant adverse cardiac events (CRACE) in patients admitted to the hospital for chest pain with an intermediate HEART score (4, 5, 6), non-diagnostic EKG, and a negative initial troponin. We conducted a retrospective analysis of all patients admitted to the University of Maryland Medical Center (UMMC) from May 2016 to May 2019 with an intermediate HEART score (4, 5, or 6), a non-diagnostic EKG, and a negative initial troponin. Our primary outcome was the rate of inpatient clinically relevant adverse cardiac events (CRACE), composite of life-threatening dysrhythmia, inpatient STEMI, cardiac or respiratory arrest, and all-cause mortality during hospitalization. A total of 1118 patients met our inclusion criteria, 6 of whom had CRACE. Overall the rate of CRACE was 0.5% (95% CI, 0.2–1.2%). Six patients (0.5%, 95% CI, 0.2%–1.2%) experienced inpatient NSTEMIs, 212 patients (19%, 95% CI, 17–21%) underwent provocative testing during their inpatient stay, 5 patients received a stent or CABG, and 5 patients had false positive non-invasive testing and underwent a negative cardiac catheterization. In this cohort of admitted patients with a documented intermediate-risk HEART score, nonischemic EKG, and negative initial troponin, the occurrence of CRACE during the index hospitalization was 0.5%.