title: New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score.
abstract: OBJECTIVE
  The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels.
  
  
  BACKGROUND
  Prognosis assessment in this population remains a challenge.
  
  
  METHODS
  A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days (similar to the Thrombolysis In Myocardial Infarction [TIMI] risk score).
  
  
  RESULTS
  Primary and secondary end point rates were 6.7% and 5.4%. A risk score was constructed using the variables related to the primary end point: chest pain score > or =10 points (hazard ratio [HR] = 2.5; 1 point), > or =2 pain episodes in last 24 h (HR = 2.2; 1 point), age > or =67 years (HR = 2.3; 1 point), insulin-dependent diabetes mellitus (HR = 4.2; 2 points), and prior percutaneous transluminal coronary angioplasty (HR = 2.2; 1 point). Patients were classified into five categories of risk (p = 0.0001): 0 points, 0% event rate; 1 point, 3.1%; 2 points, 5.4%; 3 points, 17.6%; > or =4 points, 29.6%. The accuracy of the score was greater than that of the TIMI risk score for the primary (C index of 0.78 vs. 0.66, p = 0.0002) and secondary (C index of 0.70 vs. 0.66, p = 0.1) end points.
  
  
  CONCLUSIONS
  Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score.
authors.affiliation: Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain. sanchis_juafor@gva.es
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.forename: Cristina
authors.initials: C
authors.lastname: Gómez
authors.forename: María José
authors.initials: MJ
authors.lastname: Bosch
authors.forename: Luciano
authors.initials: L
authors.lastname: Consuegra
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D002637:Chest Pain / Q000175:diagnosis; D015331:Cohort Studies; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011336:Probability; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T