Prediction of adverse cardiac outcomes in high-risk Mexican patients with chest pain in the emergency department

María F. León-Blanchet, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Diego Araiza-Garaygordobil, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Valeria Reynier-Garza, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Rodrigo Gopar-Nieto, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Nallely Belderrain-Morales, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Vianney Sarabia-Chao, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Pablo Martínez-Amezcua, Division of General Medicine, Department of Medicine, Columbia University, Irving, Medical Center, New York, USA
Alejandro Cabello-López, Occupational Health Research Unit, National Medical Center Siglo XXI, IMSS, Mexico City, Mexico
Tomas T. Sandoval-Aguilar, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico
Alexandra Arias-Mendoza, Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México City, Mexico

Objective: The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. Methods: A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. Results: A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. Conclusions: The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population.

Keywords: Chest pain. Emergency department. Acute coronary syndromes. Cardiovascular Disease. Mayor adverse cardiovascular effects.