Emergency Room Risk Stratification of Patients with Chest Pain without ST Segment Elevation

Background: Emergency room triage of patients with chest pain is an ongoing challenge.Over the years a number of modalities have been evolved for rapid diagnosis and better risk stratification of patients. Aim: to investigate the prognostic factors in patients who came to the Emergency Department with chest pain suspected of acute coronary syndrome without ST segment elevation. Patients and Methods: one-hundred and three consecutive patients (from Suez Canal university Hospital and Al Monira General Hospital) were evaluated by recording clinical history, electrocardiogram and troponin determination. Early (< 24 h) exercise testing was done for the low-risk subgroup of patients (n= 28). All patients were followed up for 3 months for major events (acute myocardial infarction or death). Results: Major events occurred in 14 patients (9.6%). Multivariate analysis identified the following predictors: age ≥65 years (OR = 1.7; p = 0.05), diabetes mellitus (OR = 2.9; p = 0.001), previous ischemic heart disease (OR = 2.5; p = 0.004), ST depression (OR = 2.1; p = 0.048) and troponin elevation (OR = 2.6; p = 0.003). These five predictors were used to construct a risk score based on their odds ratios, which allowed event risk stratification 0-3 points low risk 48% of the studied patients, 4-7 points intermediate risk 31% of the studied patients, 8 points or more high risk 21%of studied patients. Conclusions: In patients with chest pain, the combination of clinical, electrocardiographic and biochemical data available on admission to the emergency service allows rapid prognostic stratification. Early exercise testing is advisable for the final stratification of low risk patients.