HEART Score Not Predictive of Abnormal Perfusion SPECT in Emergency Department

September 17, 2019

By Brian Hoyle

CHICAGO -- September 16, 2019 -- The HEART score, which is based on chest pain, is not a reliable means of predicting an abnormal result of myocardial perfusion single-photon emission computed tomography (SPECT) and should not be used to guide emergency department (ED) treatment for coronary artery disease (CAD), according to a study presented here at the 2019 Annual Meeting of the American Society of Nuclear Cardiology (ASNC).

Makoto Nagahama, MD, University at Buffalo, Buffalo, New York, and colleagues conducted a retrospective study of 328 patients who presented to the Buffalo General Medical Center ED in 2015 for chest pain and underwent a stress myocardial perfusion SPECT in the next 6 months. The data routinely included HEART scores.

The HEART score identifies patients at low-, intermediate-, or high-risk for short-term adverse outcomes resulting from acute coronary syndrome. For the current study, abnormal myocardial perfusion SPECT was defined by either a summed stress score of ≥4 or a summed difference score of ≥2.

The results of the myocardial perfusion SPECT were abnormal for 161 (49%) patients and normal for 167 (51%) patients, with no differences in terms of age (59 years), sex (40% male), prevalence of diabetes (~25%) and hypertension (~67%), and history of smoking or CAD.

A significant difference was found between patients with abnormal versus normal myocardial perfusion SPECT values in vasodilator stress (59.1% vs 39.5%; P

Ischaemia was diagnosed in only 6.3% (mean summed difference score, 4.28) of the patients studied.

The mean HEART score was 4.18 ± 1.2 for those with an abnormal myocardial perfusion SPECT result and 3.95 ± 1.35 for those with a normal result (P = .11).

Multivariable regression analysis revealed that the HEART score was not an independent predictor of abnormal SPECT results (odds ratio [OR] = 0.88; 95% confidence interval [CI], 0.64-1.21; P = .43), after adjusting for clinically significant variables.

However, vasodilator stress was an independent predictor of abnormal SPECT results (OR = 2.16; 95% CI, 1.31-3.57; P = .002).

“[HEART score] is not an independent predictor of an abnormal myocardial perfusion SPECT and should not be routinely used to guide testing for CAD,” the authors concluded.

[Presentation title:HEART Score Does Not Predict an Abnormal Myocardial Perfusion SPECT Among Patients Presenting to the Emergency Department With Chest Pain. Abstract 100-05]