Stratification of cardiovascular risk in patients with non-traumatic chest pain in the emergency department. Perspectives of the Heart Risk Score in patients with acute coronary syndrome.

Abstract

Acute chest pain (CP) is a potentially related both to acute coronary syndrome and to other morbidities; this means that 2%-10% patients with cardiogenic CP are improperly discharged from the Emergency Room (ER). In order to identify risk to develop cardiovascular (CV) events in patients admitted to ER with CP, we used Heart Risk Score (HRS). We included 165 patients referred to the ER for non-traumatic acute CP. We retrospectively analyzed clinical records from ER and Chest Pain Unit (CPU). We calculated HRS, then we analyzed HRS sensitivity and specificity, and correlated raw data of all variables with Spearman's analysis. Diagnosis of ischemic heart disease was made in 53.9% patients referring CP. The remaining patients were affected by other non-ischemic heart disease (35.5%), gastro-esophageal disease (32.3%), pleuro-pulmonary pathology (15.8%), musculoskeletal disorders (10.5%), and panic attacks (6.6%), respectively. Patients affected by coronaropathy had hypertension (80.9%), history of cardiopathy (61.8%), chronic smoking (49.4%), hypercholesterolemia (37.0%) , diabetes (33.7%) and obesity (24.7%). Low, medium and high HRS patients were 15.7%, 59.4% and 24.8%, respectively. Risk of CV events increased with the increase of the score. The negative predictive value (NPV) in low score was 92.3%. In high score, sensitivity and specificity were 94.7% and 82.7%, respectively. Finally, the following positive Spearman's correlations were found: HRS vs its risk variables, including individual risk variables, ischemic heart disease vs CV risk factors, history of ischemic cardiac disease vs risk factors, number of stenotic vessels vs risk factors (significance values: p <0.05). HRS contains history of all risk factors for coronary artery disease and considers mild ECG and troponin alterations, giving the possibility to undertake the most appropriate path for the patient. Our work evidences relevance, reliability and ease of use of HRS in CV risk stratification in the emergency department, giving an important contribution in the evaluation of individuals who are likely to experience ischemic heart disease.