External Validation of the HEART Score for Predicting Major Adverse Cardiac events in Patients with Chest Pain in emergency department

External Validation of the HEART Score for Predicting Major Adverse Cardiac events in Patients with Chest Pain in emergency department | 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 External Validation of the HEART Score for Predicting Major Adverse Cardiac events in Patients with Chest Pain in emergency department Khedija Zaouche¹, Manel Kallel¹, Emna Rezgui¹, Emna Kallel¹, Fedia El Ayech¹ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7409179/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Coronary pathology is one of the most life-threatening causes of chest pain. A well-coded diagnosis and prognosis approach is essential. The HEART score is a valuable tool for predicting the occurrence of major adverse cardiac events (MACE) at one month. This study aimed to evaluate the prognostic value of the HEART score among patients with acute chest pain in a Tunisian emergency department (ED). Methods This was a prospective observational study conducted over a 13-month period (August 2022 - August 2023) in the ED of the Mahmoud El Matri regional hospital. We included 588 patients over 18 years of age who presented to the ED for acute non-traumatic chest pain. Epidemiological, clinical, biological, and therapeutic characteristics were recorded, and HEART scores were calculated. The primary endpoint was the occurrence of MACE at one month. Results The mean age of the 588 patients was 54 ± 15 years, with a slight male predominance (sex ratio 1.15). The main cardiovascular risk factors were hypertension (36.1%) and diabetes (30.6%). At one-month follow-up, seven patients (1.2%) experienced a MACE. The mean HEART score was 2.5 ± 1.59. The HEART score had an excellent discriminatory power, with an area under the ROC curve of 0.981 (95% CI [0.963; 0.999]; p < 0.001). For a threshold value of 4.5, its sensitivity, specificity, and negative predictive value were 100%, 89%, and 100%, respectively. Conclusion The HEART score is an effective tool for identifying patients at low risk of ischemia, allowing them to be safely discharged from the ED without further investigations. These findings support its implementation in our clinical setting, though validation on a larger scale is warranted. HEART Score Chest Pain Major Adverse Cardiac Events (MACE) Emergency Department Risk Stratification Acute Coronary Syndrome Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviews received at journal 07 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviewers agreed at journal 05 Oct, 2025 Reviewers invited by journal 05 Oct, 2025 Editor invited by journal 09 Sep, 2025 Editor assigned by journal 07 Sep, 2025 Submission checks completed at journal 07 Sep, 2025 First submitted to journal 19 Aug, 2025 You are reading this latest preprint version 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. 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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-7409179","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530231452,"identity":"88318576-930e-45d2-8096-ff2b61ad9982","order_by":0,"name":"Khedija Zaouche¹","email":"","orcid":"","institution":"Faculty of medicine of TUNIS, TUNISIA","correspondingAuthor":false,"prefix":"","firstName":"Khedija","middleName":"","lastName":"Zaouche¹","suffix":""},{"id":530231453,"identity":"bf627723-727c-45ec-b6cd-27cee54f756e","order_by":1,"name":"Manel 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department","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HEART Score, Chest Pain, Major Adverse Cardiac Events (MACE), Emergency Department, Risk Stratification, Acute Coronary Syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7409179/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7409179/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCoronary pathology is one of the most life-threatening causes of chest pain. A well-coded diagnosis and prognosis approach is essential. The HEART score is a valuable tool for predicting the occurrence of major adverse cardiac events (MACE) at one month. This study aimed to evaluate the prognostic value of the HEART score among patients with acute chest pain in a Tunisian emergency department (ED).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e This was a prospective observational study conducted over a 13-month period (August 2022 - August 2023) in the ED of the Mahmoud El Matri regional hospital. We included 588 patients over 18 years of age who presented to the ED for acute non-traumatic chest pain. Epidemiological, clinical, biological, and therapeutic characteristics were recorded, and HEART scores were calculated. The primary endpoint was the occurrence of MACE at one month.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of the 588 patients was 54\u0026thinsp;\u0026plusmn;\u0026thinsp;15 years, with a slight male predominance (sex ratio 1.15). The main cardiovascular risk factors were hypertension (36.1%) and diabetes (30.6%). At one-month follow-up, seven patients (1.2%) experienced a MACE. The mean HEART score was 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59. The HEART score had an excellent discriminatory power, with an area under the ROC curve of 0.981 (95% CI [0.963; 0.999]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For a threshold value of 4.5, its sensitivity, specificity, and negative predictive value were 100%, 89%, and 100%, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe HEART score is an effective tool for identifying patients at low risk of ischemia, allowing them to be safely discharged from the ED without further investigations. These findings support its implementation in our clinical setting, though validation on a larger scale is warranted.\u003c/p\u003e","manuscriptTitle":"External Validation of the HEART Score for Predicting Major Adverse Cardiac events in Patients with Chest Pain in emergency department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 17:22:00","doi":"10.21203/rs.3.rs-7409179/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-10-17T16:48:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T07:40:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T03:38:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"156097871714051886421645199223007169915","date":"2025-10-08T03:25:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80287642700178207597705237907728584869","date":"2025-10-07T19:28:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235434471431855155483141769400176118023","date":"2025-10-06T02:52:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-05T18:17:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T05:46:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-08T03:29:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-08T03:28:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-08-19T13:35:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"43aa7dd1-7f30-4e17-9cdc-6285e749bf70","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-16T17:22:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-16 17:22:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7409179","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7409179","identity":"rs-7409179","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}