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Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients

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Abstract

In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study. Patients admitted to the ED for non-traumatic chest pain were included, and followed-up at 6 weeks. The main study endpoint was the 6-week rate of MACE (myocardial infarction, coronary angioplasty, coronary bypass, and sudden unexplained death). 641 patients were included, of whom 9.5% presented a MACE at 6 weeks. The CARE rule was negative for 31.2% of patients, and none presented a MACE during follow-up [0, 95% confidence interval: (0.0–1.9)]. The HEART score was ≤ 3 for 63.0% of patients, and none presented a MACE during follow-up [0% (0.0–0.9)]. With an incidence below 2% in the negative group, the CARE rule seemed able to safely rule out a MACE without any biological test for one-third of patients with chest pain and the HEART score for another third with a single troponin assay.

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Authors and Affiliations

  1. Institut MITOVASC, Département de Médecine d’Urgence, CHU d’Angers, Université d’Angers, Angers, France

    Thomas Moumneh, Emilie Friou, Caroline Soulie-Chavignon, Betty Mazet-Guilaumé & Pierre-Marie Roy

  2. Service de Médecine d’Urgence, CHU de Poitiers, Poitiers, France

    Vanessa Richard-Jourjon

  3. Institut MITOVASC, Service de Cardiologie, CHU d’Angers, Université d’Angers, Angers, France

    Fabrice Prunier

  4. Service de Médecine d’Urgence, CH Le Mans, Le Mans, France

    Jacques Choukroun

  5. Unité de Formation-Recherche Santé, Université d’Angers, MINT INSERM, UMR 6021, Angers, France

    Jérémie Riou

  6. Service de Médecine d’Urgence, Cliniques Universitaires St-Luc, Brussels, Belgium

    Andréa Penaloza

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  1. Thomas Moumneh
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Correspondence to Thomas Moumneh.

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Statement of human and animal rights

 The study was approved by the Ethics Committee of the University Hospital Center of Angers on July 18th 2013, and registered N°2013/51. All procedures performed in this study were in accordance with the 1964 Helsinki declaration. This article does not contain any studies with animals performed by any of the authors.

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Each patient’s consent was expressly sought and each participant was given a written information on the study. Signed consent forms were not required regarding French current laws on observational studies.

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Moumneh, T., Richard-Jourjon, V., Friou, E. et al. Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients. Intern Emerg Med 13, 1111–1119 (2018). https://doi.org/10.1007/s11739-018-1803-4

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