The HEART score as a prognostic tool for revascularization: comment

  • Yo Sep Shin
  • Shin AhnEmail author

Dear Editor,

We read with great interest, the recent article by Oliver et al. [ 1] published in the journal. Through our letter, we aim to discuss additional findings and discrepancies with regard to the HEART score in a different setting. The researchers investigated the HEART score’s ability to identify a patient’s need for revascularization including percutaneous coronary intervention (PCI) with stents and coronary artery bypass graft (CABG). They have included all subjects who presented at the emergency department (ED) with chest pain. They did not include chest pain equivalents such as shortness of breath unless the chief complaint “chest pain” was included along with the related complaint. The area under the receiver operator curve was 0.877 [95% confidence interval (CI) 0.806–0.949] for the HEART score’s ability to predict PCI and 0.921 (95% CI 0.858–0.984) for CABG, showing strong association between the HEART score and need for revascularization. However, in real practice,...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statements on human and animal rights

Compliance with ethical standards was adhered to through Institutional Review Board approval and the study including human participants have been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

The research protocol was approved by the institutional review board of Asan Medical Center, which waived the requirement for informed consent because of the retrospective nature of this study.


  1. 1.
    Oliver JJ, Streitz MJ, Hyams JM, Wood RM, Maksimenko YM, Schauer SG, Long B, Barnwell RM, Bridwell RE, April MD (2019) The HEART score as a prognostic tool for revascularization. Intern Emerg Med. CrossRefPubMedGoogle Scholar
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    Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T (2007) Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med 167(22):2405–2413. CrossRefPubMedGoogle Scholar
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    Abidov A, Rozanski A, Hachamovitch R, Hayes SW, Aboul-Enein F, Cohen I, Friedman JD, Germano G, Berman DS (2005) Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med 353(18):1889–1898. CrossRefPubMedGoogle Scholar
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    Shin YS, Ahn S, Kim YJ, Ryoo SM, Sohn CH, Kim WY (2019) Risk stratification of patients with chest pain or anginal equivalents in the emergency department. Intern Emerg Med. CrossRefPubMedGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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