Assessing Risk of Major Adverse Cardiac Events Among Patients with Chest Pain and Cocaine Use Using the HEART Score
Authors: Neeraja Murali, Afrah Ali, Robinson Okolo, Saad Pirzada, Benoit Stryckman, Lauren Day, Daniel Lemkin, Mark Sutherland, Zachary Dezman, Quincy K Tran
Published in: American Journal of Emergency Medicine, 2024 February 4
Conclusion:
The study concludes that cocaine use as a risk factor does not significantly impact the 30-day MACE rate in patients presenting with chest pain. The HEART score remains a useful tool in risk stratification for this demographic, despite cocaine use. Clinicians are encouraged to utilize the HEART score when assessing patients with CP, regardless of cocaine status.
Methods:
- A retrospective analysis of adult patients presenting with CP across 13 EDs affiliated with a University Medical System from August 2017 to August 2021.
- Inclusion based on HEART scores calculated prospectively and urine toxicology tests performed as part of clinical evaluation.
- Performance of HEART scores and 30-day MACE occurrence were assessed using Areas Under The Receiver Operating Curve (AUROC) for both cocaine-positive (COP) and cocaine-negative (CON) groups.
Results:
- Out of 46,210 patients, 663 (1.4%) were identified as COP.
- Age distribution was similar across groups, but COP had a lower proportion of females (26.2% vs. 53.2%).
- Mean HEART score was higher in COP patients (3.7 vs. 3.1), with a larger proportion of COP patients scoring in the moderate risk category (4-6).
- 30-day MACE rates were identical (1.1%) for both groups.
- The HEART score demonstrated reasonable performance with AUROC of 0.72 for COP and 0.78 for CON groups. However, the AUROC for the Risk Factor component, including cocaine, was low (0.54) among COP patients.