Published online Aug 26, 2022. doi: 10.4330/wjc.v14.i8.454
Peer-review started: October 23, 2021
First decision: April 7, 2022
Revised: May 21, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: August 26, 2022
Timely and accurate identification of subgroup at risk for major adverse cardiovascular events among patients presenting with acute chest pain remains a challenge. Currently available risk stratification scores are suboptimal. Recently, a new scoring system called the Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) score has been shown to outperform the History, Electrocardiography, Age, Risk factors and Troponin (HEART) score, one of the most used risk scores in the United States.
To assess the potential usefulness of the SVEAT score as a risk stratification tool by comparing its performance to HEART score in chest pain patients with low suspicion for acute coronary syndrome and admitted for overnight observation.
We retrospectively reviewed medical records of 330 consecutive patients admitted to our clinical decision unit for acute chest pain between January 1st to April 17th, 2019. To avoid potential biases, investigators assigned to calculate the SVEAT, and HEART scores were blinded to the results of 30-d combined endpoint of death, acute myocardial infarction or confirmed coronary artery disease requiring revascularization or medical therapy [30-d major adverse cardiovascular event (MACE)]. An area under receiving-operator characteristic curve (AUC) for each score was then calculated. C-statistic and logistic model were used to compare predictive performance of the two scores.
A 30-d MACE was observed in 11 patients (3.33% of the subjects). The AUC of SVEAT score (0.8876, 95%CI: 0.82-0.96) was significantly higher than the AUC of HEART score (0.7962, 95%CI: 0.71-0.88), P = 0.03. Using logistic model, SVEAT score with cut-off of 4 or less significantly predicts 30-d MACE (odd ratio 1.52, 95%CI: 1.19-1.95, P = 0.001) but not the HEART score (odd ratio 1.29, 95%CI: 0.78-2.14, P = 0.32).
The SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.
Core Tip: Most chest pain risk stratification scores do not use several readily available data. The Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) score was shown to outperform the History, Electrocardiography, Age, Risk factors and Troponin (HEART) score in 30-d major adverse cardiovascular event. In our retrospective cohort study, we validated the performance of the SVEAT score and confirmed that the SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.