Abstract 9994: SVEAT Score Outperforms the HEART Score for Acute Chest Pain Risk Stratification in Patients Admitted to the Clinical Decision Unit

Abstract

Introduction: Timely and accurate identification of subgroups at risk for major adverse cardiovascular events (MACE) among patients presenting with acute chest pain remains a challenge. The HEART score is one of the most used risk stratification tools in the United States. Recently, a new scoring system based on clinical symptoms (S), history of vascular disease (V), electrocardiography (E), age (A), and serum troponin (T), SVEAT score was shown to outperform the HEART score. Hypothesis: We predicted that the SVEAT score is superior to the HEART score in predicting a 30-day MACE in patients admitted to the clinical decision unit for chest pain evaluation. Methods: Medical records of 330 consecutive patients admitted to our clinical decision unit for acute chest pain between January 1st to April 17th, 2019, were retrospectively reviewed. The 30-day MACE was the combined endpoint of death, acute myocardial infarction, or confirmed coronary artery disease that required revascularization or medical therapy. The investigators assigned to calculate the SVEAT, and HEART scores were blinded to the results of the 30-day MACE. An area under the receiver-operator characteristic curve (AUC) for each score was then calculated. The C-statistic and a logistic model were used to compare the predictive performance of the two scores. Results: A total of 11 patients (3.33%) experienced the endpoint. The AUC of the SVEAT score (0.8876, 95% C.I. 0.82 - 0.96) was significantly higher than the HEART score (0.7960, 95% C.I. 0.71 - 0.88), p = 0.03 (Fig 1). Using logistic model, a SVEAT score with a cut-off of ≤ 4 as low-risk significantly predicts 30-day MACE (odd ratio 1.52, C.I. 1.19-1.95, p = 0.001), but the HEART score did not (odd ratio 1.29, C.I. 0.78-2.14, p = 0.32). Conclusion: The SVEAT score is a superior risk stratification tool to the HEART score in low-to-intermediate-risk acute chest pain patients without apparent acute coronary syndrome.