We recently reported in this journal that the classification performance of the HEART
score is inferior in patients presenting with cocaine associated chest pain (CACP),
with 14% of those with CACP in the low risk group experiencing adverse cardiac events
within 30 days of indexed admission, compared to 4% in the general chest pain population.1 This finding suggests that the HEART score, in its current form, has limited clinical
utility in stratifying risk in those evaluated for CACP in the emergency department
(ED). Thus, we read with great interest the correspondence letter by Holmes et al.
[
[2]
] about our work, and we strongly agree with their views that an improved risk tool
should be derived to better stratify risk in CACP. Such improved risk stratification
in this group would have immediate clinical implications to everyday practice in emergency
medicine.- Holmes K.A.
- Posey R.A.
- Wang H.
The value of using the HEART score among cocaine associated chest pain patients in
the emergency department - a closer look.
Am J Emerg Med. 2020; https://doi.org/10.1016/j.ajem.2020.09.083
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References
- The prognostic value of HEART score in patients with cocaine associated chest pain: an age-and-sex matched cohort study.Am J Emerg Med. 2020; https://doi.org/10.1016/j.ajem.2020.08.074
- The value of using the HEART score among cocaine associated chest pain patients in the emergency department - a closer look.Am J Emerg Med. 2020; https://doi.org/10.1016/j.ajem.2020.09.083
- Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology.Circulation. 2008; 117: 1897-1907
- Cardiovascular effects of cocaine.Circulation. 2010; 122: 2558-2569
- The current practice for cocaine-associated chest pain in the Netherlands.Toxicol Rep. 2021; 8: 23-27
- Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group.Acad Emerg Med. 1994; 1: 330-339
- Cocaine-associated chest pain: how common is myocardial infarction?.Acad Emerg Med. 2000; 7: 873-877
- Validation of a brief observation period for patients with cocaine-associated chest pain.N Engl J Med. 2003; 348: 510-517
- Application of the TIMI risk score in ED patients with cocaine-associated chest pain.Am J Emerg Med. 2007; 25: 1015-1018
Article Info
Publication History
Published online: January 14, 2021
Accepted:
January 11,
2021
Received:
January 6,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Inc. All rights reserved.
