Background: The HEART (History, Electrocardiogram, Age, Risk factors, and Troponin) score is a widely used tool for risk stratification in patients presenting with acute chest pain. This study evaluates its sensitivity and specificity in predicting Major Adverse Cardiac Events (MACE), including Mortality, Morbidity, and other ACEs.

Methodology: A prospective cohort study was conducted at the emergency department of KVG Medical College, Sullia. Adult patients (≥18 years) with acute chest pain were categorized into low-, intermediate-, and high-risk groups based on the HEART score. Follow-up for MACE was conducted after six weeks. ROC curve analysis was performed using SPSS v27, with AUC values interpreted as excellent (0.90–1.00), good (0.80–0.89), fair (0.70–0.79), poor (0.60–0.69), and fail (<0.60) ,p-value<0.05 considered statistically significant.

Results: A total of 171 patients were analyzed. The HEART score showed excellent predictive ability for mortality (AUC: 0.824) and ACS (AUC: 0.827). A cut-off score of ≥6 for mortality had 100% sensitivity and 79% specificity, while a cut-off of ≥4 for ACS demonstrated 80% sensitivity and 71% specificity. However, it performed poorly in ruling out normal cases after follow up (AUC: 0.168).

Conclusion: The HEART score effectively predicts ACS and mortality, aiding risk stratification and emergency management. However, its limited ability to exclude normal patients after follow up highlights the need for complementary diagnostic tools.