Korean Circulation Journal

  • 제53권9호
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  • Pages.635-644
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  • 2023
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Modification of HEART Pathway for Patients With Chest Pain: A Korean Perspective

  • Bora Chae (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin Ahn (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Youn-Jung Kim (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seung Mok Ryoo (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chang Hwan Sohn (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong-Woo Seo (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Won Young Kim (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2022.12.27
  • 심사 : 2023.05.24
  • 발행 : 2023.09.01
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초록

Background and Objectives: The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. Methods: We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m2 with the conventional threshold of 30 kg/m2 in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Results: Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. Conclusions: When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.

키워드

과제정보

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government Ministry of Science and ICT (grant number: NRF-2021R1G1A101056711).

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