Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2022; 14(8): 454-461
Published online Aug 26, 2022. doi: 10.4330/wjc.v14.i8.454
SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit
Daniel Antwi-Amoabeng, Chanwit Roongsritong, Moutaz Taha, Bryce David Beutler, Munadel Awad, Ahmed Hanfy, Jasmine Ghuman, Nicholas T Manasewitsch, Sahajpreet Singh, Claire Quang, Nageshwara Gullapalli
Daniel Antwi-Amoabeng, Moutaz Taha, Bryce David Beutler, Munadel Awad, Ahmed Hanfy, Jasmine Ghuman, Nicholas T Manasewitsch, Sahajpreet Singh, Claire Quang, Nageshwara Gullapalli, Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV 89502, United States
Chanwit Roongsritong, Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, NV 89502, United States
Author contributions: Antwi-Amoabeng D and Roongsritong C helped design the research study and wrote the original draft of the manuscript; Taha M, Beutler BD, Awad M and Hanfy A contributed to data curation, validation, and formal analysis; Ghuman J, Manasewitsch NT, Singh S and Quang C contributed to data curation and helped review and edit the manuscript; Gullapalli N supervised the project from initiation to completion.
Institutional review board statement: The study protocol was reviewed and approved by the University of Nevada, Reno School of Medicine Institutional Review Board.
Informed consent statement: The study was conducted in accordance with the policies of the Institutional Review Board of the University of Nevada, Reno School of Medicine. The trial was conducted as a retrospective cohort study using anonymized data from existing records. Therefore, informed consent was not required.
Conflict-of-interest statement: The authors declare no actual or potential conflicts of interest or relationship with industry.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bryce David Beutler, MD, Doctor, Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street W-11, Reno, Nevada 89502, United States. brycebeutler@hotmail.com
Received: October 21, 2021
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
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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).

CONCLUSION

The SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.

Keywords: Acute chest pain, Risk stratification tool, Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin score, History, Electrocardiography, Age, Risk factors and Troponin score

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.