Objective: To derive and validate a prediction rule in patients with acute chest pain (CP) without existing known coronary disease. Methods: Cohort study including 2233 patients with CP. Based on clinical judgment, 1435 were discharged as very low risk and the remaining 798 underwent exercise tolerance test (ETT). End point: 6-month composite of cardiovascular death, nonfatal myocardial infarction, and revascularization. The prediction rule was derived from a randomly selected test cohort (n = 1106) summing factors of variables selected by multivariate regression analysis: CP score higher than 6 (factor of 3), male gender, age older than 50 years, metabolic syndrome, and diabetes mellitus (factor of 1, for each). The prediction rule was validated in the remaining cohort (n = 1127). All patients with CP were categorized into 3 groups: group A (prediction rule 0-1), B (2-4), or C (5-6). Outcomes and prognostic yield of ETT were compared among each group. Results: In the test cohort, 55 patients (5%) reached the composite end point. Event rate increased as the prediction rule increased: 1% for group A, 6% for B, and 25% for C (P b .001). This pattern was confirmed in the validation cohort (P b .001). A normal ETT did not significantly improve the high (99%) negative predictive value in group A and did not succeed in excluding the composite end point (17%) in group C. Conclusions: In patients with acute CP without existing coronary disease, a prediction rule based on clinical characteristics provided a useful method for prognostication with possible implication in decision making.

A new simple risk score in patients with acute chest pain without existing known coronary disease / A.Conti; S.Vanni; B.D.Taglia; B.Paladini; S.Magazzini; S.Grifoni; C.Nozzoli; G.F.Gensini. - In: THE AMERICAN JOURNAL OF EMERGENCY MEDICINE. - ISSN 0735-6757. - STAMPA. - 28:(2010), pp. 135-142. [10.1016/j.ajem.2008.10.023]

A new simple risk score in patients with acute chest pain without existing known coronary disease

A. Conti;S. Vanni;B. Paladini;S. Magazzini;S. Grifoni;C. Nozzoli;G. F. Gensini
2010

Abstract

Objective: To derive and validate a prediction rule in patients with acute chest pain (CP) without existing known coronary disease. Methods: Cohort study including 2233 patients with CP. Based on clinical judgment, 1435 were discharged as very low risk and the remaining 798 underwent exercise tolerance test (ETT). End point: 6-month composite of cardiovascular death, nonfatal myocardial infarction, and revascularization. The prediction rule was derived from a randomly selected test cohort (n = 1106) summing factors of variables selected by multivariate regression analysis: CP score higher than 6 (factor of 3), male gender, age older than 50 years, metabolic syndrome, and diabetes mellitus (factor of 1, for each). The prediction rule was validated in the remaining cohort (n = 1127). All patients with CP were categorized into 3 groups: group A (prediction rule 0-1), B (2-4), or C (5-6). Outcomes and prognostic yield of ETT were compared among each group. Results: In the test cohort, 55 patients (5%) reached the composite end point. Event rate increased as the prediction rule increased: 1% for group A, 6% for B, and 25% for C (P b .001). This pattern was confirmed in the validation cohort (P b .001). A normal ETT did not significantly improve the high (99%) negative predictive value in group A and did not succeed in excluding the composite end point (17%) in group C. Conclusions: In patients with acute CP without existing coronary disease, a prediction rule based on clinical characteristics provided a useful method for prognostication with possible implication in decision making.
2010
28
135
142
A.Conti; S.Vanni; B.D.Taglia; B.Paladini; S.Magazzini; S.Grifoni; C.Nozzoli; G.F.Gensini
File in questo prodotto:
File Dimensione Formato  
sdarticle.pdf

accesso aperto

Tipologia: Versione finale referata (Postprint, Accepted manuscript)
Licenza: Open Access
Dimensione 516.36 kB
Formato Adobe PDF
516.36 kB Adobe PDF

I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/394745
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 21
  • ???jsp.display-item.citation.isi??? 16
social impact