OBJECTIVE: We aimed to compare the predictive ability of the newly introduced Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) score with the widely used History, ECG, Age, Risk factors, and Troponin I (HEART) score in risk stratification for 30-day major adverse cardiac events (MACE) development among patients presenting to the emergency department with acute chest pain complaints.
METHODS: This prospective, observational, single-center study was conducted at an emergency department of a tertiary care hospital between June 2022 and January 2023. We recruited all adult patients aged 24 years and above with a primary complaint of non- traumatic chest pain at the critical care unit of the Emergency Department.
INCLUSION CRITERIA: Patients aged 24 years and above with a primary complaint of chest pain lasting >5 min.
EXCLUSION CRITERIA: Patients with STEMI, pregnant individuals, those with traumatic chest pain, and those without 30-day MACE data were excluded. HEART and SVEAT scores were calculated for each participant.The performance of the SVEAT score in identifying the low-risk patient group was compared to that of the HEART score.
RESULTS: In the study, out of 809 patients, 589 (72.8%) were categorized as low-risk based on the SVEAT score, and 377 (46.6%) based on the HEART score. Out of these 809 patients, 115 (14.2%) experienced MACE. Within the group classified as low risk by the SVEAT score, 6 (0.7%) patients experienced MACE, while within the group classified as low risk by the HEART score, 8 (1%) patients experienced MACE. The SVEAT score had an Area Under the Curve (AUC) of 0.916 (95% CI 0.890 to 0.942), which was found to be higher than the AUC of the HEART score (0.856, 95% CI 0.822 to 0.890). In our study, the sensitivity of the SVEAT and HEART scores was found to be 94.7% (95% CI 88.9%-98.0%) and 93.0% (95% CI 86.7%-96.9%), respectively. The specificity of both scores was 84.1% (95% CI 81.0%-86.6%) and 53.17% (95% CI 49.3%-56.6%), respectively.
CONCLUSION: While our study indicated a higher predictive power for MACE development with the SVEAT score compared to the HEART score, further extensive studies are necessary for its reliable implementation in emergency departments for chest pain risk classification.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Cardiology | |
| Emergency Medicine |
These results are consistent with two other studies and can help clinicians be more accurate in dealing with low-risk patients. The authors report hypertension and high BMI as risk indicators of ACS despite not being included in the SVEAT score. This score has shown a higher sensitivity as well as better specificity.
Very useful for clinical practice. A limitation is the study was limited to one practice center.
A new scoring system that appears superior to existing similar systems for identifying patients with low-risk chest pain who can be safely discharged.
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