HEART Score vs EDACS for Chest Pain

Written by Thomas Davis.

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In this head-to-head comparison between HEART and EDACS, EDACS identified 10% more patients as low risk with a nearly identical negative predictive value (NPV) for major adverse cardiac events (MACE) at 60 days.

Why does this matter?
The HEART score has become the dominant risk stratification scoring system for chest pain. However, several other scoring systems exist such as GRACE, TIMI, and EDACS. A prior prospective, multi-center comparison in the United States found EDACS to be the superior scoring system overall. But how would EDACS fare in a rematch?  If you have trouble keeping track of these scores, try Evidence Care (low risk chest pain section written by Dr. Amal Mattu) or MDCalc.

“Don’t phunk with my HEART.” – Black Eyed Peas
This was a retrospective analysis of 118,822 patients in the Kaiser Permanente Northern California system. The clinical documentation was electronically processed to calculate the HEART and EDACS scores. Using cTnI </= 0.04 ng/ml (99th percentile), EDACS and HEART scores identified 66.5% and 56.2% of patients as low risk, respectively. NPV for MACE at 60 days was 99.12% and 99.32%, respectively.

This study then performed a second analysis. It challenged that a 98th percentile troponin may not be normal. Among all patients with cTnI 0.02-0.04 ng/ml, they had a roughly 5-fold increase in estimated MACE at 60 days. Using this lower threshold with EDACS and HEART score improved NPV to 99.49% and 99.55%, respectively.

Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department. J Am Coll Cardiol. 2018 Feb 13;71(6):606-616. doi: 10.1016/j.jacc.2017.11.064.

Reviewed by Clay Smith.

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