Cardiology. 2022 Feb 23. doi: 10.1159/000523718. Online ahead of print.
ABSTRACT
BACKGROUND: Patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) assigned to the ‘observe’ zone of the ESC 0/1-hour algorithm form a heterogeneous group known to have an unfavourable prognosis. We aim to elucidate the clinical characteristics and management of these patients and generate a model that is predictive of a coronary diagnosis at index visit to the emergency department (ED).
METHODS: A retrospective observational cohort study including adult patients presenting to the ED with suspected NSTE-ACS assigned to the ‘observe’ zone of the ESC 0/1-hour algorithm. Multivariable logistic regression analysis was performed for the prediction of a coronary diagnosis. Internal validation was performed using bootstrap resampling.
RESULTS: 750 patients were included; mean age 66±13 years, 35% women, 50% with prior history of coronary artery disease. In 372 (50%) patients a diagnosis was established within 30-days of index presentation, of whom 169 (45%) patients had a coronary-related event. Multivariable logistic regression analysis generated a 12-point risk score incorporating 5 variables for the prediction of such event, including type of angina, chest pain occurring during inspiration, prior history of CAD, ST-segment deviation on electrocardiogram and estimated glomerular filtration rate<60. The final model had an optimism-corrected c-statistic of 0.78 (95% confidence interval [CI] 0.74-0.82). A score <6 ruled out a coronary event in 276 (37%) patients, with a sensitivity and NPV of 90% (95% CI 84-94) and 94% (91-96), respectively.
CONCLUSION: A score <6 identifies patients at low-risk of a coronary diagnosis and can guide clinical decision making in choosing the appropriate diagnostic test.
PMID:35196652 | DOI:10.1159/000523718
