Objectives: Small number of studies evaluates accuracy of initial diagnosis in patients with chest pain in primary health care, especially in relation to ishaemic heart disease. The goal of general practitioner is to differentiate patients with chest pain as a result of myocardial ishaemia from patients with more benign etiology of chest pain. The aim of this study was to estimate sensitivity and specificity of HEART score in our population for detection of positive coronary angiography finding, positive echocardiographical finding and its corelation with MACE in low risk patients with chest pain. Methods: Clinical data were reviewed retrospectively-prospectively in 585 consecutive patients with chest pain and suspected acute coronary syndrom presented to emergency department of Institute of cardiovascular diseases of Vojvodina from 2014 to 2020. Patients were devided in two groups: group with low risk (HS 0-3) and a group with intermediate risk (HS 4-6) according to the HEART score. The aim of the study was to correlate HEART score and coronary angiography finding and echocardiographical finding. Follow-up period for both group of patients was eight weeks from discharge. In this period was analysed difference between groups in survival and incidence of major adverse cardiovascular events (MACE). In addition to validation of HEART score in prediction of coronary disease and MACE, we analysed predictive value of creatine kinase MB and blood glucose levels; ejection fraction and left ventricle function,volumes and diameters. Results: Of the 585 patients with chest pain enrolled in follow up study, 125 patients (21,4%) were in group with HEART score from 0-3 and 460 patients (78,6%) in group with HEART score from 4-6. In HS group 4-6, significant coronary disease (stenosis > 50%) had 68% of patients vs. HS group 0-3 where positive finding was present in 18,4% of patients (p< 0,0005). The area under ROC curve of HEART score in detecting patients with ishaemic heart disease as a cause of chest pain was 0.771 (95% CI:0.772-0.820). The best cut-off point for the score in this regard was calculated in 3.5. The sensitivity and specificity were 89,2% and 57,6% respectively. Integrating gender, creatine kinaze MB, glucose blood level and HEART score, the AUROC curve of this model was 0.828 (95% CI:0.786-0.869; p < 0,0005). The cut-off point was 77.95. The sensitivity and specificity were 84,9% and 68% respectively. Left ventricle wall movement abnormalitiy was present in 20,8% patients with HS 0 – 3 vs. 70,65% of patients in HS group 4 -6 (p < 0,05). In eight week follow up period arter discharge, there was significant difference in MACE between groups ( HS 0-3 6,4% vs. HS 4-6 16,7% p < 0,05). Conclusion: The HEART score for chest pain patients presented to general practitioner or emergency department physician, provides a quick and reliable prediction of ishaemic heart disease as a couse of chest pain, left ventricular disfunction and MACE.