الفهرس 
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Abstract
Chest pain accounts for approximately 5% to 10% of emergency department (ED) visits and is one of the most common complaints among all ED visits worldwide. A significant number of chest pain patient visits result in hospitalization to rule out acute coronary syndrome, although few patients require cardiac interventions.
This clinical practice consequently results in substantial patient overassessment, wasted allocation of already limited health care resources, and increased financial burden for both patients and the overall health care system.
In recent years, multiple chest pain risk-stratification scoring systems (e.g., Thrombolysis in Myocardial Infarction (TIMI), Global Registry of Acute Coronary Events (GRACE)) have been derived and validated in different studies.
However, most scoring systems are intended to evaluate shortterm outcomes, such as mortality or recurrence of myocardial infarction, among hospitalized chest pain patients with history of coronary artery disease. Although their use can be expanded to all chest pain patients, scant evidence exists to support such claims.
Originally derived in Europe, the History, ECG, Age, Risk Factors, and Troponin (HEART) score is an alternative chest pain risk-stratification tool intended specifically to identify low-risk chest pain patients at the ED and predict potential major adverse cardiac events after ED discharge.
HEART score has been suggested to facilitate accurate diagnosis and to predict short-term outcome in patients with chest pain. Using HEART score in the ED may, therefore, decrease the admission rate. Unnecessary investigations and costs may be thereby avoided. Several scientific societies are encouraging the use of HEART score, for evaluating patients with chest pain suggestive of ACS in the ED.
However, most of the studies validating the HEART score were conducted in high-income countries, so the current study aimed to perform an external validation of the HEART score in the emergency department in one of the major tertiary care hospitals in Egypt, the Menoufia University hospital.
This prospective and cross-sectional study included 268 patients with chest pain. They were selected according to certain inclusion and exclusion criteria. All patients were subjected to: full history taking, clinical examination including general and local examination and investigations including laboratory investigation: complete blood count and troponin, Electrocardiography and Echocardiography if needed. We calculated HEART score for those patients by a combination of results from 5 categories :(History, ECG, Age, Risk Factors, Troponin) then we followed up each patient regarding Major Adverse Cardiac Event (MACE).
The HEART score seemed to be reliable in predicting the major adverse cardiac events in chest pain patients in the emergency department with excellent specificity and sensitivity.