目的 探讨HEART评分及其各指标对急性胸痛患者发生心搏骤停的预测价值。 方法 采用病例对照研究法,收集2017年1月1日—2019年12月31日某省急救中心抢救室的急性胸痛患者的病历资料,发生心搏骤停的71例胸痛患者为病例组,随机选取同期未发生心搏骤停的142例胸痛患者为对照组,分析两组间HEART评分及其各指标对心搏骤停的预测能力。 结果 病例组HEART得分(7.52±1.61)高于对照组(4.77±2.65),ROC曲线下的面积为0.81[95%CI(0.75~0.86)],差异均具有统计学意义(P<0.001)。随着HEART分值的增加,发生心搏骤停的风险呈上升趋势。HEART评分中5项指标曲线下的面积依次为：心电图(0.77)、肌钙蛋白(0.72)、病史(0.70)、年龄(0.60)、危险因素(0.60),差异均具有统计学意义(P<0.05)。 结论 HEART评分对急性胸痛患者发生心搏骤停具有较高的预测价值,建议运用于各级医疗机构,建立HEART的评分标准及使用流程,分层管理胸痛患者。

Objective To evaluate the accuracy of HEART score for predicting cardiac arrest in patients with chest pain in the emergency department. Methods We conducted a retrospective case-control study in a provincial emergency center from January 1,2017 to December 31,2019. The chest pain patients who experienced cardiac arrest were identified as the case group(n=71). Those who did not experienced cardiac arrest were treated as the control group(n=142). The predictive ability of HEART score and its indicators for prediction of cardiac arrest between the two groups were analyzed. Results The HEART score of the case group(7.52±1.61) was significantly higher than that of the control group(4.77±2.65)(P<0.001),and the area under the ROC curve was 0.81[95%CI(0.75~0.86),P<0.001]. With the increase of the HEART score,it showed a generally linear upward trend of the risk of cardiac arrest. The AUC of the five indicators of HEART score were：electrocardiograph(0.77),troponin(0.72),history(0.70),age(0.60),and risk factor(0.60). Conclusion HEART score performed well for predicting cardiac arrest in chest pain patients in the emergency department. We recommend that applying HEART score and establishing HEART pathway for hierarchical management of patients with chest pain.