The HET (history, electrocardiogram, and troponin) score has low efficacy and negative predictive value in a multisite U.S. cohort study

Introduction: The History, Electrocardiogram, and Troponin (HET) score is a simplified alternative to the HEART score for risk stratifying emergency department (ED) patients with chest pain. This study evaluates the safety and efficacy of the HET score for 30-day cardiac death or myocardial infarction (MI).

Methods: We conducted a secondary analysis of the STOP-CP multisite cohort study. Risk score components were determined prospectively by the treating provider. Patients were classified into low-, intermediate-, and high-risk strata based on HEART and HET scores. Negative predictive value (NPV) was calculated for the primary safety outcome of cardiac death or MI at 30 days. Consistent with prior studies, the commonly accepted threshold of NPV ≥ 99 % was used to define safety. Efficacy was the proportion of patients classified as low risk. NPV and efficacy were compared between HET and HEART scores using generalized score statistic and McNemar's test, respectively.

Results: Among 1460 patients, 46.3 % (676/1460) were women and the mean age was 57.6 ± 12.8 years. Cardiac death or MI at 30 days occurred in 12.7 % (186/1460). Among patients with a low-risk HET score, 1.4 % (4/286) experienced 30-day cardiac death or MI, while 2.2 % (12/534) of patients with a low-risk HEART score had 30-day cardiac death or MI. This yielded a NPV for 30-day of 98.6 % (95 % CI 96.5-99.6 %) for the HET score vs 97.8 % (95 % CI 96.1-98.8 %) for the HEART score (p = 0.29).Efficacy of the HET score was 19.6 % (286/1460, 95 % CI 17.6-21.6 %) vs 36.6 % (534/1460, 95 % CI 34.1-39.1 %) for the HEART score (p < 0.001).

Conclusion: In a multisite US cohort study, neither the HET score nor the HEART score achieved a safe NPV. The HET score had significantly lower efficacy than the HEART score.

Trial registration: High-Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP-CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436).