TOPLINE:

The integration of male sex, right bundle branch block (RBBB), and haemoglobin and glucose levels with the HEART (history, ECG, age, risk factors, and troponin levels) score enhanced its ability to predict significant coronary artery stenosis in patients with suspected acute coronary syndrome (ACS). The enhanced model improved the diagnostic accuracy by 13.5% in patients with low- or moderate-risk HEART scores.

METHODOLOGY:

• Researchers conducted a retrospective observational study of 379 consecutive patients (mean age, 61 years; SD, 15 years; 57% men) presenting to the emergency department with suspected ACS from April 2022 to July 2024.
• Inclusion criteria were patients whose initial assessments did not allow for definitive exclusion or confirmation of ACS and who were referred for urgent coronary CT angiography (CCTA) scan.
• The analysis focused on the diagnostic accuracy by comparing the HEART score against findings of significant coronary artery stenosis (defined as ≥ 70% stenosis on CCTA).
• Logistic regression identified independent predictors of significant coronary artery stenosis in patients initially classified as low-to-moderate risk.
• The area under the curve (AUC) and improvement in net reclassification were used to evaluate the performance of an updated score after incorporating the identified clinical variables.

TAKEAWAY:

• According to the HEART score stratification, 27% of patients were at low risk, 67% were at moderate risk, and 6% were at high risk, with a significant incidence of a positive CCTA scan observed in 7%, 27%, and 67%, respectively.
• Male sex (odds ratio [OR], 1.76), RBBB (OR, 4.15), haemoglobin levels (OR, 1.21), and glucose levels (OR, 1.07) independently predicted significant coronary artery stenosis in patients with low- or moderate-risk HEART scores.
• The integration of these variables into the HEART score improved the AUC from 0.68 to 0.74 (P = .004), with a net reclassification improvement of 13.5% (P = .032) in patients with low- or moderate-risk HEART scores.
• The enhanced model maintained robust prognostic accuracy across relevant patient subgroups, ensuring the reliable prediction of positive CCTA outcomes irrespective of clinical and laboratory variations.

IN PRACTICE:

"This study demonstrated the potential of an enhanced HEART score model to improve the accuracy for predicting significant coronary artery stenosis in patients presenting to the ED [emergency department] with suspected ACS and considered to be at low-to-moderate risk," the authors wrote.

"By incorporating additional simple clinical and laboratory variables, the model offers a promising tool for risk stratification, addressing critical gaps in current diagnostic practices," they added.

SOURCE:

This study was led by Michele Della Rocca, Centro Cardiologico Monzino IRCCS, Milan, Italy. It was published online on February 11, 2026, in the Journal of Clinical Medicine.

LIMITATIONS:

The retrospective single-centre design and specific cohort characteristics, including the low proportion of patients with prior revascularisation, might have introduced selection bias and limited causal inference and generalisability. Positive CCTA findings did not directly correspond to the clinical diagnosis of ACS or the immediate need for revascularisation. Advanced imaging markers such as coronary calcium burden and plaque phenotype were unavailable for the analysis.

DISCLOSURES:

This study did not receive any external funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.