J Korean Soc Emerg Med.  2022 Dec;33(6):552-564.

The difference of the HEART score for predicting cardiovascular disease according to obesity index in emergency department

• Kim S
• Chung H
• Lee Y
• Jang HY
• Cho YS
• Park JB
• Kim SI
• Seo BS
• Sohn Y

Abstract

Objective
The HEART score is a fast and simple cardiovascular disease (CVD) prediction tool useful in the emergency department (ED). This study evaluates the predictive value of the HEART score when applying other obesity indices such as waist circumference (WC) or waist-to-height ratio (WHtR) instead of body mass index (BMI).
Methods
Data were prospectively collected from the pre-made registry of patients who had visited the ED with chest pain. Based on their final diagnoses and coronary imaging study results, patients were classified as acute coronary syndrome (ACS), non-ACS, significant coronary arterial stenosis (SCS), and non-SCS. We compared the HEART score for each group and modified it with variable obesity indices. Multivariable logistic regression and the area under the curve were calculated to determine the most suitable obesity index for the HEART score in predicting ACS or SCS. In addition, we compared the gender-dependent relationship between obesity and ACS or SCS.
Results
Of the total 689 patients examined, 281 were diagnosed with ACS. The odds ratio (OR) of the HEART score for ACS was 12.1. The ORs were 13.2 and 11.2 when the HEART score was modified with WC or WHtR, respectively. Obesity was determined as the meaningful factor to predict ACS (OR: BMI, 2.38; WC, 3.39) and SCS (OR: BMI, 3.07; WC, 4.03) in women but not men.
Conclusion
The HEART score showed good predictive value regardless of obesity index modification. Furthermore, obesity is associated with CVD in women with chest pain, but not in men.

Keyword

Chest pain; Acute coronary syndrome; Obesity; Gender