{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T19:02:11Z","timestamp":1770836531026,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The HEART score is a widely used risk-stratification tool in suspected acute coronary syndrome (ACS), but it still suffers from several limitations. We aim to assess its diagnostic accuracy for predicting coronary computed tomography angiography (CCTA) findings and explore possible enhancement by integrating additional clinical variables. Methods: In this retrospective, observational study, consecutive patients presenting to the Emergency Department with suspected ACS and undergoing CCTA were analyzed. The study assessed the HEART score\u2019s diagnostic accuracy for predicting significant coronary artery stenosis (defined as \u226570% stenosis at CCTA) and explored improvements by integrating additional clinical variables for low-to-moderate-risk patients. Results: Three hundred seventy-nine patients were enrolled (age: 61 \u00b1 15 years; male: 57%). According to the HEART score, 27% were at low risk, 67% moderate risk, and 6% high risk, with a prevalence of significant CAD of 7%, 27%, and 67%, respectively. The area under the curve (AUC) of the HEART score to predict significant CAD was 0.68. Male gender (OR = 1.76, 95% CI 1.03\u20133.02), right bundle branch block (OR = 4.15, 95% CI 1.66\u201310.40), and hemoglobin (OR = 1.21) and glucose levels (OR = 1.01) independently predicted significant coronary stenosis at CCTA in patients at low-to-moderate risk. Integrating these variables into the HEART score, the AUC improved from 0.68 to 0.74 (p = 0.004), with a net reclassification improvement of 13.5% (p = 0.032). Conclusions: Integrating additional clinical variables into the HEART score improves its accuracy to predict significant coronary artery stenosis at CCTA in suspected ACS patients at low-to-moderate risk. Tailoring assessments with these variables supports more accurate patient management and highlights the potential for more comprehensive diagnostic approaches.<\/jats:p>","DOI":"10.3390\/jcm15041424","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:45:36Z","timestamp":1770831936000},"page":"1424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy Improvement of an Updated HEART Score to Predict Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography"],"prefix":"10.3390","volume":"15","author":[{"given":"Michele","family":"Della Rocca","sequence":"first","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Ferdico","sequence":"additional","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-3106","authenticated-orcid":false,"given":"Nicola","family":"Cosentino","sequence":"additional","affiliation":[{"name":"Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5409-0791","authenticated-orcid":false,"given":"Alice","family":"Bonomi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-4529","authenticated-orcid":false,"given":"Andrea","family":"Baggiano","sequence":"additional","affiliation":[{"name":"Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-1362","authenticated-orcid":false,"given":"Manuela","family":"Muratori","sequence":"additional","affiliation":[{"name":"Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4168-2207","authenticated-orcid":false,"given":"Saima","family":"Mushtaq","sequence":"additional","affiliation":[{"name":"Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Salvini","sequence":"additional","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3373-7741","authenticated-orcid":false,"given":"Matteo","family":"Biroli","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edona","family":"Leka","sequence":"additional","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Pontone","sequence":"additional","affiliation":[{"name":"Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Grazi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Assanelli","sequence":"additional","affiliation":[{"name":"Department of Emergency and Urgent Cardiac Care, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1136\/hrt.2003.027599","article-title":"The health care burden of acute chest pain","volume":"91","author":"Goodacre","year":"2005","journal-title":"Heart"},{"key":"ref_2","first-page":"e368","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR Guideline for the Evaluation and Diagnosis of 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