New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score.
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.
Sanchis
Juan
J
Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain. sanchis_juafor@gva.es
Bodí
Vicent
V
Núñez
Julio
J
Bertomeu-González
Vicente
V
Gómez
Cristina
C
Bosch
María José
MJ
Consuegra
Luciano
L
Bosch
Xavier
X
Chorro
Francisco J
FJ
Llàcer
Angel
A
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*
D020107:Troponin T