A New Risk Score for Patients With Acute Chest Pain and Normal High Sensitivity Troponin

Area of Science:

• Cardiology
• Emergency Medicine
• Risk Stratification

Background:

• Acute chest pain is a common emergency department presentation.
• Normal high-sensitivity troponin I (hs-TnI) levels do not always rule out major adverse cardiac events (MACE).
• Accurate risk stratification is crucial for timely patient management.

Purpose of the Study:

• To develop and validate a novel risk score for predicting MACE in patients presenting with acute chest pain and normal hs-TnI.
• To identify key predictors of MACE in this patient population.
• To improve risk assessment and triage in the emergency department.

Main Methods:

• A derivation cohort of 724 patients with acute chest pain and normal hs-TnI was analyzed.
• Logistic regression identified significant predictors: male sex, history of chest pain, age ≥60 years, and ≥3 coronary artery disease (CAD) risk factors.
• External validation was performed in an independent cohort of 352 patients.

Main Results:

• The developed risk score demonstrated good predictive performance.
• The area under the curve (AUC) for the receiver operating characteristic (ROC) was 0.80 in the derivation cohort and 0.79 in the validation cohort.
• The validation cohort showed consistent risk stratification patterns with the derivation cohort.

Conclusions:

• A new risk score effectively predicts MACE in acute chest pain patients with normal hs-TnI and no known CAD or ST-segment deviation.
• This score can assist emergency department clinicians in risk assessment and patient triage.
• Further implementation may optimize care pathways for patients with acute chest pain.