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New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a
Juan Sanchis1, Vicent Bodí, Julio Núñez
1Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain. sanchis_juafor@gva.es
Insights
A new risk score accurately predicts adverse events in chest pain patients with normal ECGs and troponin levels. This tool improves upon the TIMI risk score for better patient stratification and outcomes.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Emergency Medicine
Background:
- Assessing prognosis for patients with chest pain, normal electrocardiograms (ECGs), and troponin levels is challenging.
- This patient group has a non-negligible risk of adverse events, including mortality and myocardial infarction, within one year.
Purpose of the Study:
- To develop and validate a novel risk score for stratifying patients presenting with chest pain, normal ECGs, and normal troponin levels.
- To compare the accuracy of the new risk score against the existing Thrombolysis In Myocardial Infarction (TIMI) risk score.
Main Methods:
- A cohort of 646 patients with chest pain, normal ECGs, and normal troponin levels were evaluated.
- Clinical history, ECG, and early exercise testing were used. Exclusion criteria included ST-segment deviation and troponin elevation.
- The primary endpoint was all-cause mortality or myocardial infarction at one year; the secondary endpoint included urgent revascularization at 14 days.
Main Results:
- A risk score was developed using variables such as chest pain score, pain episodes, age, diabetes, and prior percutaneous transluminal coronary angioplasty.
- Patients were categorized into five risk groups, with event rates ranging from 0% to 29.6%.
- The developed risk score demonstrated superior accuracy (C-index 0.78) compared to the TIMI risk score (C-index 0.66) for the primary endpoint.
Conclusions:
- Patients with chest pain, normal ECGs, and normal troponin levels have a significant risk of adverse cardiovascular events.
- The newly developed risk score provides more accurate risk stratification for this specific population than the TIMI risk score.
- This tool can aid clinicians in better managing patients with low-risk acute chest pain presentations.
Objectives:
The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels.
Background:
Prognosis assessment in this population remains a challenge.
Methods:
A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days (similar to the Thrombolysis In Myocardial Infarction [TIMI] risk score).
Results:
Primary and secondary end point rates were 6.7% and 5.4%. A risk score was constructed using the variables related to the primary end point: chest pain score > or =10 points (hazard ratio [HR] = 2.5; 1 point), > or =2 pain episodes in last 24 h (HR = 2.2; 1 point), age > or =67 years (HR = 2.3; 1 point), insulin-dependent diabetes mellitus (HR = 4.2; 2 points), and prior percutaneous transluminal coronary angioplasty (HR = 2.2; 1 point). Patients were classified into five categories of risk (p = 0.0001): 0 points, 0% event rate; 1 point, 3.1%; 2 points, 5.4%; 3 points, 17.6%; > or =4 points, 29.6%. The accuracy of the score was greater than that of the TIMI risk score for the primary (C index of 0.78 vs. 0.66, p = 0.0002) and secondary (C index of 0.70 vs. 0.66, p = 0.1) end points.
Conclusions:
Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score.
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