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
Processing time: 299 Days and 10.2 Hours
Cardiovascular disease is the leading cause of death worldwide. Early identification of patients at risk for major cardiovascular events can expedite treatment and significantly reduce morbidity and mortality.
Risk stratification scoring systems used to identify patients at risk of major cardiovascular events, including the History, Electrocardiography, Age, Risk factors and Troponin (HEART) score, are often ineffective and may exclude many patients who would benefit from urgent intervention.
We aimed to assess the value of a new risk stratification scoring system, the Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT), by comparing its performance to that of the HEART score among chest pain patients with low suspicion for acute coronary syndrome.
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 required revascularization or medical therapy [30-d major adverse cardiovascular event (MACE)].
A 30-d MACE was observed in 11 patients (3.33% of the subjects). The area under receiving-operator characteristic curve (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.
In our study, the SVEAT score was superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients. Future research is warranted to evaluate the SVEAT score among large, heterogeneous populations and among high-risk individuals presenting with chest pain.