Does the HEART score predict major adverse cardiac events in emergency department chest pain patients?

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Why is this study important?

Assessment of chest pain and related symptoms requires accurate and timely identification of patients with acute coronary syndrome (ACS), while minimizing the costs and harms of over-investigation. The American Heart Association (AHA) and the American College of Cardiology (ACC) have recommended clinical scores for emergency department (ED) chest pain risk stratification. The Thrombolysis in Myocardial Infarction (TIMI) score and the Global Registry of Acute Coronary Events (GRACE) were derived from inpatients with confirmed ACS. The HEART (History, Electrocardiogram, Age, Risk Factors and Troponin) score was created for ED patients with suspected ACS to discriminate between those patients at low risk of short-term major adverse cardiac events (MACE) and those at higher risk for appropriate treatment. This systematic review summarizes the prognostic accuracy of the HEART score for prediction of MACE.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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