HEART-score can be simplified without loss of discriminatory power in patients with chest pain - Introducing the HET-score

Am J Emerg Med. 2023 Dec:74:104-111. doi: 10.1016/j.ajem.2023.09.037. Epub 2023 Oct 1.


Background: The History, Electrocardiogram (ECG), Age, Risk factors and Troponin, (HEART) score is useful for early risk stratification in chest pain patients. The aim was to validate previous findings that a simplified score using history, ECG and troponin (HET-score) has similar ability to stratify risk.

Methods: Patients presenting with chest pain with duration of ≥10 min and an onset of last episode ≤12 h but without ST-segment elevation on ECG at 6 emergency departments were eligible for inclusion. The HEART-score and the simplified HET-score were calculated. The endpoint was a composite of myocardial infarction (MI) as index diagnosis, readmission due to new MI or death within 30 days.

Results: HEART-score identified 32% as low risk (0-2p), 47% as intermediate risk (3-5p), and 20% as high risk (6-10p) patients. The endpoint occurred in 0.5%, 7.3% and 35.7%, respectively. HET-score identified 39%, 42% and 19% as low- (0p), intermediate- (1-2p) and high-risk (3-6p) patients, with the endpoint occurring in 0.6%, 6.2% and 43.2%, respectively. When all variables included in the HEART-score were included in a multivariable logistic regression analysis, only History (OR, CI [95%]): 2.97(2.16-4.09), ECG (1.61[1.14-2.28]) and troponin level (5.21[3.91-6.95]) were significantly associated with cardiovascular events. When HEART- and HET-score were compared in a ROC-analysis, HET-score had a significantly larger AUC (0.887 vs 0.853, p < 0.001).

Conclusions: Compared with HEART-score, HET-score is simpler and appears to have similar ability to discriminate between chest pain patients with and without cardiovascular event.

Keywords: Acute coronary syndrome; Chest pain; Diagnosis; Prognosis; Score.

MeSH terms

  • Acute Coronary Syndrome* / diagnosis
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Electrocardiography
  • Emergency Service, Hospital
  • Humans
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnosis
  • Risk Assessment
  • Risk Factors
  • Troponin


  • Troponin