[Emergency room risk stratification of patients with chest pain without ST segment elevation].
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.
Sanchis
Juan
J
Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, Valencia, España. sanchis_juafor@gva.es
Bodí
Vicent
V
Llácer
Angel
A
Facila
Lorenzo
L
Pellicer
Mauricio
M
Bertomeu
Vicente
V
Núñez
Julio
J
Ruiz
Vicent
V
Chorro
Francisco J
FJ
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
D014336:Troponin