title: Risk stratification in chest pain patients undergoing nuclear stress testing: the Erlanger Stress Score.
abstract: BACKGROUND
  Studies have individually reported the relationship of age, cardiac risk factors, and history of preexisting coronary artery disease (CAD) for predicting acute coronary syndromes in chest pain patients undergoing cardiac stress testing. In this study, we investigate the interplay of all these factors on the incidence of acute coronary syndromes to develop a tool that may assist physicians in the selection of appropriate chest pain patients for stress testing.
  
  
  METHODS
  Retrospective analysis of a prospectively acquired database of consecutive chest pain patients undergoing nuclear stress testing. Backward stepwise logistic regression was used to develop a model for predicting risk of 30-day acute coronary events (ACE) using information obtained from age, sex, cardiac risk factors, and history of preexisting CAD.
  
  
  RESULTS
  A total of 800 chest pain patients underwent nuclear stress testing. ACE occurred in 74 patients (9.3%). Logistic regression analysis found only 6 factors predictive of ACE: age, male sex, preexisting CAD, diabetes, and hyperlipidemia. Area under the receiver operator characteristic curve of this model for predicting ACE was 0.767 (95% confidence interval, 0.719-0.815). There were no cases of ACE in the 173 patients with predicted probability estimates ≤2.5% (95% confidence interval, 0%-2.1%).
  
  
  CONCLUSIONS
  A regression model using age, sex, preexisting CAD, diabetes, and hyperlipidemia is predictive of 30-day ACE in chest pain patients undergoing nuclear stress testing. Prospective studies need to be performed to determine whether this model can assist physicians in the selection of appropriate low-to-intermediate risk chest pain patients for nuclear stress testing.
authors.affiliation: Department of Emergency Medicine, University of Tennessee College of Medicine-Chattanooga, TN, USA. francis.fesmire@erlanger.org
authors.forename: Francis M
authors.initials: FM
authors.lastname: Fesmire
authors.forename: Ron C
authors.initials: RC
authors.lastname: Buchheit
authors.forename: Yu
authors.initials: Y
authors.lastname: Cao
authors.forename: Harry W
authors.initials: HW
authors.lastname: Severance
authors.forename: Yi
authors.initials: Y
authors.lastname: Jang
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Heath
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers