title: [Emergency room risk stratification of patients with chest pain without ST segment elevation].
abstract: OBJECTIVE
  To investigate the prognostic factors in patients who come to the emergency room with chest pain but without ST segment elevation.
  
  
  METHODS
  743 consecutive patients were evaluated by recording clinical history, electrocardiogram and troponin I determination, and early (<24 h) exercise testing was done for the low-risk subgroup of patients (n=203). All patients were followed during 3 months for major events (acute myocardial infarction or death).
  
  
  RESULTS
  Major events occurred in 71 patients (9.6%). Multivariate analysis (C statistic=0.79; 95% CI 0.73-0.84; p=0.0001) identified the following predictors: age > or =72 years (OR=1.7; 95% CI, 1.0-2.9; p=0.05), insulin-dependent diabetes mellitus (OR=2.9; 95% CI, 1.5-5.4; p=0.001), previous ischemic heart disease (OR=1.9; 95% CI, 1.1-3.2; p=0.02), ST depression (OR=2.1; 95% CI, 1.2-3.8; p=0.01) and troponin I elevation (OR=2.9; 95% CI, 1.5-5.3; p=0.001). These five predictors were used to construct a risk score based on their odds ratios, which allowed event rate stratification by quartiles of the score: 0-2 points (1.6% events), 3-4 points (8.1% events), 5-7 points (11.9% events) and > or =8 points (26.2% events); p=0.0001. No patient with negative findings in the early exercise testing had major events.
  
  
  CONCLUSIONS
  In patients with chest pain, the combination of clinical, electrocardiographic and biochemical data available on admission to the emergency service allows rapid prognostic stratification. Early exercise testing is advisable for the final stratification of low risk patients.
authors.affiliation: Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, Valencia, España. sanchis_juafor@gva.es
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Facila
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pellicer
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Vicent
authors.initials: V
authors.lastname: Ruiz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D018570:Risk Assessment; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin