[Predictive value of chest pain score for the diagnosis of acute coronary syndromes].
OBJECTIVE
We analyzed the diagnostic utility of a chest pain score in patients evaluated for chest pain of possible coronary origin.


METHODS
We studied 1,068 consecutive patients coming to the emergency room with acute chest pain of possible coronary origin without ST-segment elevation, using a chest pain unit protocol. Chest pain was quantified by validated score (0-20 points). The diagnostic value of the chest pain score was analyzed for the diagnosis of acute myocardial infarction (AMI), unstable angina (UA) and acute coronary syndrome (ACS; AMI or UA).


RESULTS
The diagnosis of ACS was established in 651 patients (61%), AMI in 439 (41%) and UA in 212 (20%). In the multivariate analysis a chest pain score > or = 10 was an independent predictor of ACS (odds ratio [OR] = 2.9; 95% confidence interval [CI] 2.1-4; p = 0.0001), along with an age older than 70 years (OR = 2.6; 95% CI,1.8-3.7; p = 0.0001), male gender (OR = 2; 95% CI, 1.4-2.8; p = 0.0001); insulin-dependent diabetes (OR = 2.3; 95% CI, 1.2-4.6; p = 0.016); previous myocardial infarction (OR = 1.6; 95% CI, 1.1-2.4; p = 0.022), ST depression (OR = 9.3; 95% CI, 5.2-16.7; p = 0.0001) and T wave inversion (OR = 2.5; 95% CI, 1.4-4.3; p = 0.0001). The chest pain score was associated with the diagnosis of both AMI (OR = 1.4; 95% CI, 1.1-1.9; p < 0.02) and UA (OR = 2.8; 95% CI, 1.8-4.2; p < 0.0001).


CONCLUSIONS
The chest pain score allows independent information for the early diagnosis of patients coming to the emergency department with acute chest pain of possible coronary origin.
Ruiz-Ros
Vicente
V
Servicio de Cardiología, Hospital Clínic Universitari de València, Universitat de València, València, Spain. vicente.ruiz@uv.es
Sanchis-Forés
Juan
J
Bodí-Peris
Vicente
V
Núñez-Villota
Julio
J
Gómez-Monsoliu
Cristina
C
Bosch-Campos
María José
MJ
Ruiz-Aguilar
Cristina
C
Llàcer-Escorihuela
Angel
A
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis*; D000789:Angina, Unstable / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index