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Development and validation of a comprehensive early risk prediction model for patients with undifferentiated acute
Luke P Dawson1,2,3, Emily Andrew2,4, Ziad Nehme2,4,5
1Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.
Insights
A new risk score, ECAMM, offers comprehensive assessment for undifferentiated chest pain, improving upon existing models. This tool aids clinical decisions for non-coronary investigations and safe early discharge.
Area of Science:
- Emergency Medicine
- Cardiology
- Clinical Risk Prediction
Background:
- Existing chest pain risk scores often focus narrowly on coronary events.
- Comprehensive risk assessment is needed for undifferentiated chest pain, considering alternate serious diagnoses.
- Current models may not adequately guide decisions for non-coronary investigations.
Purpose of the Study:
- To develop and validate an all-inclusive risk prediction model for patients with undifferentiated chest pain.
- To create a model that accounts for a composite outcome beyond just coronary events.
- To improve risk stratification for non-traumatic chest pain assessed by emergency medical services.
Main Methods:
- Developed a multivariable logistic regression model using a large population-based cohort (January 2015-June 2019).
- Randomly divided the cohort into development (70%) and validation (30%) sets.
- Defined a composite outcome including hospital admission, 30-day all-cause mortality, or 30-day myocardial infarction (MI).
Main Results:
- The composite outcome occurred in 28.4% of patients.
- The developed Early Chest pain Admission, MI, and Mortality (ECAMM) risk model showed good discrimination (C-statistic 0.775 in development, 0.765 in validation).
- ECAMM demonstrated superior discriminatory performance compared to existing risk scores for undifferentiated chest pain.
Conclusions:
- The ECAMM risk score provides an all-inclusive assessment for non-traumatic chest pain.
- It addresses limitations of single-outcome focused risk scores.
- Clinically useful for guiding decisions on non-coronary investigations and safe early discharge.
Aims:
Existing risk scores for undifferentiated chest pain focus on excluding coronary events and do not represent a comprehensive risk assessment if an alternate serious diagnosis is present. This study aimed to develop and validate an all-inclusive risk prediction model among patients with undifferentiated chest pain.
Methods:
We developed and validated a multivariable logistic regression model for a composite measure of early all-inclusive risk (defined as hospital admission excluding a discharge diagnosis of non-specific pain, 30-day all-cause mortality, or 30-day myocardial infarction [MI]) among adults assessed by emergency medical services (EMS) for non-traumatic chest pain using a large population-based cohort (January 2015 to June 2019). The cohort was randomly divided into development (146,507 patients [70%]) and validation (62,788 patients [30%]) cohorts.
Results:
The composite outcome occurred in 28.4%, comprising hospital admission in 27.7%, mortality within 30-days in 1.8%, and MI within 30-days in 0.4%. The Early Chest pain Admission, MI, and Mortality (ECAMM) risk model was developed, demonstrating good discrimination in the development (C-statistic 0.775, 95% CI 0.772-0.777) and validation cohorts (C-statistic 0.765, 95% CI 0.761-0.769) with excellent calibration. Discriminatory performance for the composite outcome and individual components was higher than existing scores commonly used in undifferentiated chest pain risk stratification.
Conclusions:
The ECAMM risk score model can be used as an all-inclusive risk stratification assessment of patients with non-traumatic chest pain without the limitation of a single diagnostic outcome. This model could be clinically useful to help guide decisions surrounding the need for non-coronary investigations and safety of early discharge.
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