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Master Thesis

Évaluation de l’impact du HEART Score dans la douleur thoracique suspecte du syndrome coronarien aigu aux urgence

Abstract : Chest pain is one of the most common reasons for consultation in the emergency department. The main diagnosis representing a life-threatening emergency with a short-term issue is acute coronary syndrome, which accounts for 15% of non-traumatic chest pain. Many predictive scores help improve the management of SCA. Among them, the HEART Score seems to be the most adapted in the emergency setting because it's a diagnostic tool with a good predictive value, particularly negative in the low prevalence population. The criteria of the HEART Score are divided into 5 points: History, Electrocardiogram, Age, Risk factors and Troponinemia. It divides patients into 3 categories of ACS risk: low, intermediate and high. We wanted to evaluate it on the population having consulted to the Adults' Emergency Department of Charles Nicolle University Hospital of Rouen in order to determine if its application could allow the patients presenting low risk chest pain to return at home early with a quasi guarantee of no cardiac event within 6 weeks.
Materials and methods:
this is a single-center, retrospective, observational, cohort study of 481 patients who set at the CHU Charles Nicolle emergency department with chest pain as a first complaint from January 1 to April 30, 2017. The initial clinical and biological characteristics of all patients consecutive patients who consulted the ER during this period for chest pain were analyzed. The HEART Score has been applied to each of them.
During the inclusion period, 1649 files were analyzed and 481 (29%) were included. After applying the HEART Score, patients were divided into 3 categories: 312 (65%) t low risk, 127 at intermediate risk, and 42 at high risk of ACS. The power of the HEART Score was analyzed through a ROC curve. Its specificity and negative predictive value are powerful in the low-risk SCA patient category.
The HEART Score is an interesting tool for daily practice that could allow emergency disengagement by having patients at low risk of SCA returned to their homes earlier. In order to validate this study, it would be necessary to evaluate its application in a prospective multicenter cohort with a larger population.
Document type :
Master Thesis
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Submitted on : Tuesday, May 21, 2019 - 9:53:12 AM
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Marie Valin. Évaluation de l’impact du HEART Score dans la douleur thoracique suspecte du syndrome coronarien aigu aux urgence. Médecine humaine et pathologie. 2018. ⟨dumas-01920832⟩