Related Experiment Video
Updated: Feb 2, 2026
Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
The objective CORE score allows early rule out in acute chest pain patients
Catharina Borna1, Knut Kollberg1, David Larsson1
1a Section of Emergency Medicine, Department of Clinical Sciences at Lund , Lund University , Lund , Sweden.
Insights
A new clinical objective rule-out evaluation (CORE) effectively identifies low-risk chest pain patients. This tool helps safely discharge one-third of patients from the emergency department, reducing unnecessary cardiac investigations.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Decision Rules
Background:
- Chest pain is a frequent emergency department complaint, posing a challenge for timely patient discharge.
- Accurate identification of low-risk patients is crucial to avoid unnecessary investigations and hospital stays.
Purpose of the Study:
- To develop a simple, objective decision rule for identifying emergency department patients with chest pain who are at low risk for 30-day major adverse cardiac events (MACE).
Main Methods:
- Prospective analysis of chest pain patients using the Clinical Objective Rule-out Evaluation (CORE) criteria.
- CORE incorporates high-sensitivity cardiac troponin T (hs-cTnT) levels at 0 and 2 hours, plus a risk score (age, arterial disease, hypertension, diabetes).
- Low risk was defined by hs-cTnT ≤14 ng/L at both time points and a risk score of 0.
Main Results:
- The CORE rule identified 33% of 751 patients as low risk for 30-day MACE.
- The rule demonstrated high sensitivity (98.9%) and negative predictive value (99.6%) for MACE.
- Adding ECG interpretation did not enhance the diagnostic performance of the CORE rule.
Conclusions:
- The CORE rule is a simple, objective tool to identify a significant proportion of chest pain patients with very low 30-day MACE risk.
- Patients identified as low risk by CORE may be candidates for early discharge without further acute coronary syndrome investigations.
Objectives:
Chest pain is a common complaint in the emergency department (ED), and it is a challenge to identify low-risk chest pain patients eligible for early discharge. We aimed to develop a simple objective decision rule to exclude 30-day major adverse cardiac events (MACE) in ED chest pain patients.
Design:
We analyzed prospectively included patients presenting with chest pain. Low risk patients were identified with the clinical objective rule-out evaluation (CORE). CORE was based on high sensitivity cardiac troponin T (hs-cTnT) tests at ED presentation (0 h) and 2 h later together with a simplified risk score consisting of four objective variables: age ≥65 years and a history of arterial disease, hypertension or diabetes. For the patient to be classified as low risk in the CORE rule, hs-cTnT had to be ≤14 ng/L both at 0 and 2 h, and the sum of the risk score had to be 0. The primary outcome was MACE within 30 days.
Results:
Among the 751 patients in the final analysis, 90 (11.9%) had a MACE. CORE identified 248 (33%) of patients as low risk with a sensitivity of 98.9% (CI 93.1-99.9) and a negative predictive value of 99.6% (95% CI 97.4-100) for 30-day MACE. Adding the ED physician's interpretation of the ECG to CORE did not improve diagnostic performance.
Conclusion:
A simple objective decision rule (CORE) identified one-third of all patients as having a very low 30-day risk of MACE. These patients may potentially be discharged without additional investigations for acute coronary syndrome.
More Related Videos
06:04Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
07:14A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery
Published on: January 18, 2018
Related Concept Videos
03:02The Aufbau Principle and Hund's Rule
02:10The Nucleosome Core Particle
The paradox
Nucleosomes, paradoxically, perform two opposite functions simultaneously. On the one hand, their main responsibility is to protect the delicate DNA strands from physical damage and help achieve a higher compaction ratio. While on the other hand, they must allow polymerase enzymes to access DNA...
02:55Exceptions to the Octet Rule
01:24Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:24Chest Physiotherapy
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...