Objective To study HEART risk score in chest pain patients with coronary heart disease （CHD）in the emergency department（ED）. Methods This retrospective cohort study used a prospectively acquired database. Chest pain patients admitted to the emergency department of Beijing Anzhen Hospital from September 2014 to July 2015 were enrolled. Baseline characteristics of patients were included. The endpoint（major adverse cardiovascular events，MACE）was a composite of acute myocardial infarction，percutaneous coronary interven⁃ tion，coronary artery bypass graft，and all ⁃ cause death within 3 months after initial presentation. Results The study enrolled 377 eligible patients，and 186 patients（49.3%）had a MACE within 3 months. A significant pro⁃ gressive pattern of increasing MACE rate was observed as the score increased（P < 0.001 by chi⁃square for trend）. The area under the receiver operating characteristic（ROC）curve was 0.73［95% CI：0.68 ~ 0.78］in all chest pain patients. Patients were categorized into three groups：low risk（score 2 ~ 3），intermediate risk（score 4 ~ 5）， and high risk（score 6~10）；MACE rates were 8.3%（1/12），38.3%（72/188）and 83.8%（113/177），respectively （P < 0.001）. Recommendations for patient triage were different. Conclusions The HEART risk score was validat⁃ ed in chest pain patients with CHD and may aid patients triage in the ED.