• Marcus Eng Hock Ong, Ken Goh, Stephanie Fook-Chong, Benjamin Haaland, Khin Lay Wai, Zhi Xiong Koh, Nur Shahidah, and Zhiping Lin.
• Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. Marcus.ong.e.h@sgh.com.sg
• Am J Emerg Med. 2013 Aug 1;31(8):1201-7.

BackgroundWe aimed to develop a risk score incorporating heart rate variability (HRV) and traditional vital signs for the prediction of early mortality and complications in patients during the initial presentation to the emergency department (ED) with chest pain.MethodsWe conducted a prospective observational study of patients with a primary complaint of chest pain at the ED of a tertiary hospital. The primary outcome was a composite of mortality, cardiac arrest, ventricular tachycardia, hypotension requiring inotropes or intraaortic balloon pump insertion, intubation or mechanical ventilation, complete heart block, bradycardia requiring pacing, and recurrent ischemia requiring revascularization, all within 72 hours of arrival at ED.ResultsThree hundred nine patients were recruited, and 25 patients met the primary outcome. Backwards stepwise logistic regression was used to derive a scoring model that included heart rate, systolic blood pressure, respiratory rate, and low frequency to high frequency ratio. For predicting complications within 72 hours, the risk score performed with an area under the curve of 0.835 (95% confidence interval [CI], 0.749-0.920); and a cutoff of 4 and higher in the risk score gave a sensitivity of 0.880 (95% CI, 0.677-0.968), specificity of 0.680 (95% CI, 0.621-0.733), positive predictive value of 0.195, and negative predictive value of 0.985. The risk score performed better than ST elevation/depression and troponin T in predicting complications within 72 hours.ConclusionA risk score incorporating heart rate variability and vital signs performed well in predicting mortality and other complications within 72 hours after arrival at ED in patients with chest pain.Copyright © 2013 Elsevier Inc. All rights reserved.

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