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Stratification of chest pain in the emergency department: how effectively do risk scores predict coronary artery stenosis?
Session:
SESSÃO DE POSTERS 08 - DOENÇAS CARDIOVASCULARES - PROGNÓSTICO NO SCA
Speaker:
André Manuel Martins
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
André Manuel Faustino Martins; Margarida Cabral; Joana Pereira; Mónica Amado; Adriana Vazão; Carolina Gonçalves; Mariana Carvalho; Hélia Martins
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Chest pain (CP) is a common presenting symptom in emergency departments (ED), where a key task is to confirm or exclude acute coronary syndrome (ACS). Several risk stratification scoring systems have emerged, with the HEART, EDACS, and T-MACS scores being readily applicable in clinical practice.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives:</strong> To assess the performance of the HEART, EDACS, and T-MACS scores in predicting ACS with significant coronary artery stenosis (SCS) in pts presenting with CP to the ED of a regional hospital in Portugal.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> <span style="color:black">Retrospective single-center study of adult pts admitted to the </span>ED with CP and classified as very urgent by the Manchester system during the first 5 months of 2022<span style="color:black">. Pts with ST-segment elevation myocardial infarction, traumatic CP or those in the postoperative period of cardiothoracic surgery were excluded. </span>Pts with suspected ACS underwent cardiac catheterization (CC) and were classified into two groups: Group 1, consisting of pts with significant coronary artery stenosis (SCS), defined as ≥70% coronary artery stenosis; and Group 2, which included ACS patients without SCS and non-ACS patients. Demographic data were recorded, and the HEART, EDACS, and T-MACS scores were calculated for each patient. Group comparisons were performed.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 480 pts were included; median age was 59 yrs (IQR 27) and 241 pts (50.2%) were male. The baseline characteristics are presented in Table 1. 46 pts (9.6%) underwent CC due to suspected ACS, and 34 (7.1%) were found to have SCS (Group 1). Group 1 pts were significantly older and had a higher prevalence of diabetes, hypertension, dyslipidemia and history of coronary artery disease (Table 1). The EDACS score showed the lowest discriminatory capacity for ACS-SCS, with an area under the curve (AUC) of 0.846 (p<0.001) and a score ≥16.5 yielding 85% sensitivity and 76% specificity. <span style="color:black">In contrast, the HEART and T-MACS scores showed superior discriminatory accuracy for ACS-SCS (AUC 0.956 and 0.947, respectively; p<0.001), with a HEART score ≥6.5 yielding 82% sensitivity and 46% specificity, and a T-MACS score ≥0.229 showing 97% sensitivity and 90% specificity. However, it is important to note that both the HEART and T-MACS scores have </span>limited discriminatory ability for predicting ACS-SCS in pts with moderate risk.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong> The HEART, EDACS, and T-MACS scores are valuable tools for SCS, enabling the prioritization of CP pts in ED and ensuring timely interventions and efficient resource allocation.</span></span></span></p>
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