title: Risk scores prognostic implementation in patients with chest pain and nondiagnostic electrocardiograms.
abstract: BACKGROUND
  Several risk scores are available for prognostic purpose in patients presenting with chest pain.
  
  
  OBJECTIVE
  The aim of this study was to compare Grace, Pursuit, Thrombolysis in Myocardial Infarction (TIMI), Goldman, Sanchis, and Florence Prediction Rule (FPR) to exercise electrocardiogram (ECG), decision making, and outcome in the emergency setting.
  
  
  METHODS
  Patients with nondiagnostic ECGs and normal troponins and without history of coronary disease underwent exercise ECG. Patients with positive testing underwent coronary angiography; otherwise, they were discharged. End point was the composite of coronary stenosis at angiography or cardiovascular death, myocardial infarction, angina, and revascularization at 12-month follow-up.
  
  
  RESULTS
  Of 508 patients considered, 320 had no history of coronary disease: 29 were unable to perform exercise testing, and finally, 291 were enrolled. Areas under the receiver operating characteristic curves for Grace, Pursuit, TIMI, Goldman, Sanchis, and FPR were 0.59, 0.68, 0.69, 0.543, 0.66, and 0.74, respectively (P < .05 FPR vs Goldman and Grace). In patients with negative exercise ECG and overall low risk score, only the FPR effectively succeeded in recognizing those who achieved the end point; in patients with high risk score, the additional presence of carotid stenosis and recurrent angina predicted the end point (odds ratio, 12 and 5, respectively). Overall, logistic regression analysis including exercise ECG, coronary risk factors, and risk scores showed that exercise ECG was an independent predictor of coronary events (P < .001).
  
  
  CONCLUSIONS
  The FPR effectively succeeds in ruling out coronary events in patients categorized with overall low risk score. Exercise ECG, nonetheless being an independent predictor of coronary events could be considered questionable in this subset of patients.
authors.affiliation: Emergency Medicine, Department of Critical Care Medicine and Surgery, University of Florence and Careggi University Hospital, 50134 Florence, Italy. aaaconti@hotmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.forename: Claudio
authors.initials: C
authors.lastname: Poggioni
authors.forename: Gabriele
authors.initials: G
authors.lastname: Viviani
authors.forename: Yuri
authors.initials: Y
authors.lastname: Mariannini
authors.forename: Margherita
authors.initials: M
authors.lastname: Luzzi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cerini
authors.forename: Erica
authors.initials: E
authors.lastname: Canuti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
mesh_terms: D002637:Chest Pain / Q000175:diagnosis* / Q000503:physiopathology; D016009:Chi-Square Distribution; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors