Assessing the Utility of the HEART Score in the Era of High-Sensitivity Troponin

Assessing the Utility of the HEART Score in the Era of High-Sensitivity Troponin | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing the Utility of the HEART Score in the Era of High-Sensitivity Troponin Ethan F. Kramer, Jonathan Van Name, Rogina Rezk, Nicolas J. Abchee, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6585586/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract There is uncertainty in the clinical utility of the HEART score, given its incorporation of an older generation of troponin assay. We sought to determine whether high-sensitivity troponin I (Hs-TnI) alone can effectively stratify cardiovascular risk in patients presenting to the emergency department (ED) with moderate or high HEART score by analyzing the management and outcomes of adults presenting to our ED with chest pain, moderate or high HEART score, and Hs-TnI below the 99 th percentile. For this population, we calculated the negative predictive value (NPV) of Hs-TnI in ruling out a major adverse cardiac event (MACE; defined as myocardial infarction or death from a cardiovascular or unknown cause) at 30 days. Of 1331 patients included, 374 were admitted. Admitted patients underwent more stress tests (44.4% vs. 1.1%; p<0.01) and diagnostic catheterizations (14.9% vs. 0.0%; p<0.01). CT angiography was higher in those discharged (19.1% vs. 24.4%; p=0.05). Patients admitted were more frequently discharged with new antiplatelets, statins, and anti-anginals (16.0% vs. 0.3%, 15.7% vs. 0.8%, and 15.7% vs. 1.2%; p<0.01 for all comparisons). The overall incidence of 30-day MACE was 0.2%. Hs-TnI below the 99th percentile had an NPV of 99.8% in ruling out MACE at 30 days. In summary, in this cohort of patients with moderate or high HEART score, Hs-TnI below the 99 th percentile alone had a very high NPV in ruling out MACE at 30 days. On average, admitted patients had more comorbidities and more intense management despite a similar event rate compared to those discharged. HEART Score High-Sensitivity Troponin Troponin I Acute Coronary Syndrome Chest Pain Full Text Additional Declarations The authors declare potential competing interests as follows: Dr. Allen has received research support and funding from Beckman Coulter, Roche Diagnostics, Bristol-Myers Squibb, and Siemens, and acts on the advisory board and consults for Beckman Coulter, Abbott, and Roche Diagnostics. All other authors have no disclosures. Cite Share Download PDF Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6585586","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457012007,"identity":"84af4b4f-c84b-44af-b045-db4115536801","order_by":0,"name":"Ethan F. 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We sought to determine whether high-sensitivity troponin I (Hs-TnI) alone can effectively stratify cardiovascular risk in patients presenting to the emergency department (ED) with moderate or high HEART score by analyzing the management and outcomes of adults presenting to our ED with chest pain, moderate or high HEART score, and Hs-TnI below the 99\u003csup\u003eth\u003c/sup\u003e percentile. For this population, we calculated the negative predictive value (NPV) of Hs-TnI in ruling out a major adverse cardiac event (MACE; defined as myocardial infarction or death from a cardiovascular or unknown cause) at 30 days. Of 1331 patients included, 374 were admitted. Admitted patients underwent more stress tests (44.4% vs. 1.1%; p\u0026lt;0.01) and diagnostic catheterizations (14.9% vs. 0.0%; p\u0026lt;0.01). CT angiography was higher in those discharged (19.1% vs. 24.4%; p=0.05). Patients admitted were more frequently discharged with new antiplatelets, statins, and anti-anginals (16.0% vs. 0.3%, 15.7% vs. 0.8%, and 15.7% vs. 1.2%; p\u0026lt;0.01 for all comparisons). The overall incidence of 30-day MACE was 0.2%. Hs-TnI below the 99th percentile had an NPV of 99.8% in ruling out MACE at 30 days. In summary, in this cohort of patients with moderate or high HEART score, Hs-TnI below the 99\u003csup\u003eth\u003c/sup\u003e percentile alone had a very high NPV in ruling out MACE at 30 days. On average, admitted patients had more comorbidities and more intense management despite a similar event rate compared to those discharged.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Assessing the Utility of the HEART Score in the Era of High-Sensitivity Troponin","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-06-16 18:30:47","doi":"10.21203/rs.3.rs-6585586/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2025-05-15 10:11:21","doi":"10.21203/rs.3.rs-6585586/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5f91def-0f68-4197-b47e-b0bc7991d502","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-04T08:59:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 18:30:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-6585586","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6585586","identity":"rs-6585586","version":["v2"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}