INTRODUCTION Although increasing evidence shows that in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) both hospital and pre-hospital acquired HEART (History, ECG, Age, Risk factors, Troponin) scores have strong predictive value, pre-hospital and hospital acquired HEART scores have never been compared directly. METHODS In patients with suspected NSTE-ACS, the HEART score was independently prospectively assessed in the pre-hospital setting by ambulance paramedics and in the hospital by physicians. The hospital HEART score was considered the gold standard. Low-risk (HEART score ≤3) was considered a negative test. Endpoint was occurrence of major adverse events within 45 days. RESULTS A total of 699 patients were included in the analyses. In 516 (74%) patients pre-hospital and hospital risk classification was similar, in 50 (7%) pre-hospital risk classification was false negative (45 days mortality 0%) and in 133 (19%) false positive (45 days mortality 1.5%). False negative risk classifications were caused by differences in history (100%), risk factor assessment (66%) and troponin (18%) and were more common in older patients. Occurrence of major adverse events was comparable in pre-hospital and hospital low-risk patients (2.9% vs. 2.7%, p = 0.9). Incidence of major adverse events was 0% in the true negative group, 26% in the true positive group, 10% in the false negative group and 5% in the false positive group. Predictive value of both pre-hospital and hospital acquired HEART scores was high, although the 'area under the curve' of hospital acquired HEART score was higher (0.84 vs. 0.74, p < 0.001). CONCLUSION In approximately 25% of patients hospital and pre-hospital HEART score risk classifications disagree, mainly by risk overestimation in the pre-hospital group. Since disagreement is primarily caused by different scoring of history and risk factors, additional training may improve pre-hospital scoring.

中文翻译：

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院前与医院获得的 HEART 评分对疑似非 ST 段抬高急性冠状动脉综合征的风险分类

引言 尽管越来越多的证据表明，在疑似非 ST 段抬高急性冠状动脉综合征 (NSTE-ACS) 的患者中，住院和院前获得性 HEART（病史、心电图、年龄、危险因素、肌钙蛋白）评分都具有很强的预测价值，预- 从未直接比较医院和医院获得的 HEART 评分。方法 在疑似 NSTE-ACS 的患者中，HEART 评分由救护车护理人员在院前环境中和在医院由医生独立前瞻性地评估。医院 HEART 评分被认为是金标准。低风险（HEART 评分≤3）被认为是阴性测试。终点是 45 天内发生的主要不良事件。结果 共有 699 名患者被纳入分析。在 516 名 (74%) 患者中，院前和住院风险分类相似，50 例（7%）院前风险分类为假阴性（45 天死亡率为 0%），133 例（19%）为假阳性（45 天死亡率为 1.5%）。假阴性风险分类是由病史 (100%)、风险因素评估 (66%) 和肌钙蛋白 (18%) 的差异引起的，并且在老年患者中更为常见。院前和住院低风险患者的主要不良事件发生率相当（2.9% vs. 2.7%，p = 0.9）。真阴性组主要不良事件发生率为0%，真阳性组为26%，假阴性组为10%，假阳性组为5%。尽管医院获得性 HEART 评分的“曲线下面积”较高（0.84 对 0.74，p < 0.001），但院前和医院获得性 HEART 评分的预测值均较高。结论 大约 25% 的患者住院和院前 HEART 评分的风险分类不一致，主要是由于院前组的风险高估。由于分歧主要是由病史和风险因素的不同评分引起的，额外的培训可能会提高院前评分。