New scoring system for acute chest pain risk stratification: Is it worth SVEAT-ing it?

Abstract

The emergency room is a very potent environment in the hospital. With the growing demands of the population, improved accessibility to health resources, and the onslaught of the triple pandemic, it is extremely crucial to triage patients at presentation. In the spectrum of complaints, chest pain is the commonest. Despite it being a daily ailment, chest pain brings concern to every physician at first. Chest pain could span from acute coronary syndrome, pulmonary embolism, and aortic dissection (all potentially fatal) to reflux, zoster, or musculoskeletal causes that do not need rapid interventions. We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making. Over the years, the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events. Recently, a new scoring system called SVEAT was developed and compared to the HEART score. We have attempted to summarize how these scoring systems differ and their generalizability. With an increasing number of scoring systems being introduced, one must also prevent anchorage bias; i.e., tools such as these are only diagnosis-specific and not organ-specific, and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.

Keywords: Chest pain, Acute coronary syndrome, SVEAT score, HEART score, TIMI score, Risk stratification scores

Core Tip: Despite several studies, scoring systems, and artificial intelligence -guided tools available to triage symptoms of chest pain, physicians are often struck with the dilemma before discharging patients from the endoplasmic reticulum. The reason is that chest pain etiologies such as acute coronary syndromes (ACS) can present atypically and, when misdiagnosed, can lead to catastrophic consequences. Tools such as the HEART score and recently published SVEAT score are robustly validated methods of triaging this conundrum. However, while we delineate how they differ, one must be mindful that most patients with ACS could present with chest pain, but not every chest pain is due to ACS.