Predictive Performance of the HEART Score for Acute Coronary Syndrome with Significant Coronary Stenosis in Patients with Non–ST-Elevation Acute Chest Pain

Background: Chest pain is a leading cause of emergency department (ED) visits, requiring rapid identification of acute coronary syndrome (ACS). The HEART score is widely used for risk stratification, although its ability to identify ACS associated with significant coronary artery stenosis (SCS) remains incompletely studied. This study evaluates its diagnostic performance in patients with acute chest pain. Methods: A retrospective analysis included patients presenting to the ED with non–ST-elevation chest pain triaged as very urgent by the Manchester Triage System. Patients with ACS underwent invasive coronary angiography. Based on the final diagnosis and angiographic findings, patients were classified into two groups: (1) ACS with SCS and (2) non-ACS or ACS without SCS. The HEART score was retrospectively calculated. Diagnostic performance for ACS with SCS was assessed using sensitivity, specificity, and receiver operating characteristic curve analysis. Results: Of 480 patients, 34 had ACS with SCS. The HEART score demonstrated high discriminative performance (AUC = 0.956; 95% CI 0.929–0.983), with sensitivity 88.2% and specificity 87.9% at a cut-off of ≥6. Conclusions: The HEART score showed strong diagnostic performance for ACS with SCS in ED patients with non–ST-elevation chest pain and may support early identification of patients requiring invasive coronary evaluation.