• Clinical cardiology · Apr 2019

    Effective combination of isolated symptom variables to help stratifying acute undifferentiated chest pain in the emergency department.

    • Wen Zheng, Jingjing Ma, Shuo Wu, Guangmei Wang, He Zhang, Jiaqi Zheng, Feng Xu, Jiali Wang, and Yuguo Chen.
    • Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
    • Clin Cardiol. 2019 Apr 1; 42 (4): 467-475.

    BackgroundSymptom is still indispensable for the stratification of chest pain in the emergency department. However, it is a sophisticated aggregation of several aspects of characteristics and effective combination of those variables remains deficient. We aimed to develop and validate a chest pain symptom score (CPSS) to address this issue.HypothesisThe CPSS may help stratifying acute undifferentiated chest pain in ED.MethodsPatients with non-ST segment elevation chest pain and negative cardiac troponin (cTn) over 3 hours after symptom onset were consecutively recruited as the derivation cohort. Logistic regression analyses identified statistical predictors from all symptom aspects for 30-day acute myocardial infarction (AMI) or death. The performance of CPSS was compared with the symptom classification methods of the history variable in the history, electrocardiograph, age, risk factors, troponin (HEART) score. This new model was validated in a separated cohort of patients with negative cTn within 3 hours.ResultsSeven predictors in four aspects of chest pain symptom were identified. The CPSS was an independent predictor for 30-day AMI or death (P < 0.001). In the derivation (n = 1434) and validation (n = 976) cohorts, the expected and observed event rates were well calibrated (Hosmer-Lemeshow test P > 0.30), and the c-statistics of CPSS were 0.72 and 0.73, separately, significantly better than the previous history classifications in HEART score (P < 0.001). Replacing the history variable with the CPSS improved the discrimination and risk classification of HEART score significantly (P < 0.001).ConclusionsThe effective combination of isolated variables was meaningful to make the most stratification value of symptoms. This model should be considered as part of a comprehensive strategy for chest pain triage.© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

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