{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:09:17Z","timestamp":1784182157339,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical risk scores for acute chest pain evaluation were largely validated using older troponin assays. We sought to analyze the HEART score and clinical decision pathways utilizing high sensitivity troponin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective study of all adult patients presenting with nontraumatic chest pain to a single center, quaternary-care emergency department over a 6-month time period. Patients were risk-stratified by the HEART score using an institution-specific clinical decision pathway that aligns with current guidelines. Predictive models and optimal cutoff values were constructed via logistic regression for the primary outcome of acute coronary syndrome at presentation or major adverse cardiovascular events within 30 days and additional analysis was performed among risk groups assessing associations of HEART score with negative troponin and electrocardiogram compared to positive troponin or electrocardiogram.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 1,014 patients were included for analysis with 46 patients (4.5%) meeting the primary outcome. The model most associated with the primary outcome utilized electrocardiogram and high-sensitivity troponin only (C-statistic\u2009=\u20090.883), which reliably predicted the absence of the primary outcome in intermediate risk patients. The addition of medical history, risk factors, and age to this model (via the continuous HEART score) did not increase its value (C-Statistic 0.876).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study suggests that high-sensitivity troponin and electrocardiogram alone can be used to risk stratify most patients with acute chest pain appropriately. Traditional scoring systems developed with contemporary cardiac troponin assays have less utility in the era of high sensitivity troponin, especially with patients previously deemed intermediate risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1867018","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:40:05Z","timestamp":1784180405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The HEART score has less utility with high sensitivity troponin"],"prefix":"10.3389","volume":"13","author":[{"given":"Austin","family":"Harris","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kory","family":"Heier","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey F.","family":"Spindel","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weston","family":"McCowan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Slade","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansi","family":"Parekh","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dealla","family":"Samadi","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine and Pediatrics, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedant","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky","place":["Lexington, KY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"B1","author":"Cairns","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1136\/emermed-2020-210306","article-title":"National trends in chest pain visits in US emergency departments (2006\u20132016)","volume":"37","author":"Aalam","year":"2020","journal-title":"Emerg Med J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1001\/jamainternmed.2016.2498","article-title":"A national study of the prevalence of life-threatening diagnoses in patients with chest pain","volume":"176","author":"Hsia","year":"2016","journal-title":"JAMA Intern Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e187","DOI":"10.1016\/j.jacc.2021.07.053","article-title":"021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"78","author":"Gulati","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1016\/j.jacc.2012.02.035","article-title":"2-Hour Accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial","volume":"59","author":"Than","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/1742-6723.12164","article-title":"Development and validation of the emergency department assessment of chest pain score and 2h accelerated diagnostic protocol","volume":"26","author":"Than","year":"2014","journal-title":"Emerg Med Australas"},{"key":"B7","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1001\/jama.284.7.835","article-title":"The TIMI risk score for unstable angina\/non-ST elevation MI: a method for prognostication and therapeutic decision making","volume":"284","author":"Antman","year":"2000","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1007\/BF03086144","article-title":"Chest pain in the emergency room: value of the HEART score","volume":"16","author":"Six","year":"2008","journal-title":"Neth Heart J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1056\/NEJMoa0900428","article-title":"Early diagnosis of myocardial infarction with sensitive cardiac troponin assays","volume":"361","author":"Reichlin","year":"2009","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s11886-017-0904-4","article-title":"High-Sensitivity cardiac troponin for the diagnosis of patients with acute coronary syndromes","volume":"19","author":"Vasile","year":"2017","journal-title":"Curr Cardiol Rep"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1161\/CIRCULATIONAHA.120.049298","article-title":"Diagnostic performance of high-sensitivity cardiac troponin T strategies and clinical variables in a multisite US cohort","volume":"143","author":"Allen","year":"2021","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/HPC.0000000000000230","article-title":"Baseline high sensitivity cardiac troponin I level below limit of quantitation rules out acute myocardial infarction in the emergency department","volume":"20","author":"Cook","year":"2021","journal-title":"Crit Pathw Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.annemergmed.2016.01.001","article-title":"Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice","volume":"68","author":"Than","year":"2016","journal-title":"Ann Emerg Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1177\/2048872618755369","article-title":"A direct comparison of decision rules for early discharge of suspected acute coronary syndromes in the era of high sensitivity troponin","volume":"8","author":"Chew","year":"2019","journal-title":"European Heart Journal Acute Cardiovascular Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1111\/acem.13649","article-title":"Prognostic accuracy of the HEART score for prediction of Major adverse cardiac events in patients presenting with chest pain: a systematic review and meta-analysis","volume":"26","author":"Fernando","year":"2019","journal-title":"Acad Emerg Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/HPC.0b013e31828b327e","article-title":"The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study","volume":"12","author":"Six","year":"2013","journal-title":"Crit Pathw Cardiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1177\/2048872620935399","article-title":"Performance of the European Society of Cardiology 0\/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin: systematic review and meta-analysis","volume":"10","author":"Burgos","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC)","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)","volume":"37","author":"Roffi","year":"2016","journal-title":"Eur Heart J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e202508","DOI":"10.21542\/gcsp.2025.8","article-title":"Utilization and outcomes of single-troponin discharge from the emergency department in a low-risk population","volume":"2025","author":"Zhou","year":"2025","journal-title":"Global Cardiology Science and Practice"},{"key":"B21","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.annemergmed.2023.04.024","article-title":"HEART Score recalibration using higher sensitivity troponin T","volume":"82","author":"Khand","year":"2023","journal-title":"Ann Emerg Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s11739-017-1612-1","article-title":"Cardiac biomarkers of acute coronary syndrome: from history to high-sensitivity cardiac troponin","volume":"12","author":"Garg","year":"2017","journal-title":"Intern Emerg Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e368","DOI":"10.1161\/CIR.0000000000001029","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"144","author":"Gulati","year":"2021","journal-title":"Circulation"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e660","DOI":"10.1016\/j.jemermed.2024.02.008","article-title":"Improvement of emergency department chest pain evaluation using hs-cTnT and a risk stratification pathway","volume":"66","author":"Zhou","year":"2024","journal-title":"J Emerg Med"},{"key":"B25","volume-title":"Statistical Analysis with Missing Data. 3rd edn","author":"Little","year":"2019"},{"key":"B26","doi-asserted-by":"crossref","DOI":"10.1002\/9780470316696","volume-title":"Multiple Imputation for Nonresponse in Surveys","author":"Rubin","year":"1987"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1161\/CIRCULATIONAHA.113.001258","article-title":"Unstable angina: is it time for a requiem?","volume":"127","author":"Braunwald","year":"2013","journal-title":"Circulation"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e5703","DOI":"10.1097\/MD.0000000000005703","article-title":"Prognostic value of basal high-sensitive cardiac troponin levels on mortality in the general population: a meta-analysis","volume":"95","author":"van Der Linden","year":"2016","journal-title":"Medicine (Baltimore)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1111\/acem.13221","article-title":"Validation of the No objective testing rule and comparison to the HEART pathway","volume":"24","author":"Stopyra","year":"2017","journal-title":"Acad Emerg Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1177\/2048872616658591","article-title":"High-sensitivity cardiac troponin assays and unstable angina","volume":"7","author":"Sandoval","year":"2018","journal-title":"European Heart Journal Acute Cardiovascular Care"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1136\/heartjnl-2018-314305","article-title":"Incidence and outcomes of unstable angina compared with non-ST-elevation myocardial infarction","volume":"105","author":"Puelacher","year":"2019","journal-title":"Heart"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2529","DOI":"10.1056\/NEJMoa1803377","article-title":"Application of high-sensitivity troponin in suspected myocardial infarction","volume":"380","author":"Neumann","year":"2019","journal-title":"N Engl J Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/S0140-6736(18)31923-8","article-title":"High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial","volume":"392","author":"Shah","year":"2018","journal-title":"Lancet"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1867018\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:40:07Z","timestamp":1784180407000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1867018\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":33,"alternative-id":["10.3389\/fcvm.2026.1867018"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1867018","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"article-number":"1867018"}}