SVEAT vs. HEART scores for avoiding unnecessary coronary referrals in ED chest pain patients without cath labs

BACKGROUND: Risk stratification of emergency department (ED) patients presenting with chest pain is particularly challenging in hospitals without catheterization laboratory facilities, often leading to unnecessary coronary referrals. OBJECTIVES: To evaluate and compare the predictive performance of the SVEAT and HEART scores for 30-day major adverse cardiac events (MACE) in ED chest pain patients referred from non-PCI centers and to examine their potential to reduce unnecessary coronary referrals. METHODS: This prospective observational study included 230 adult patients with non-traumatic chest pain who were referred to a coronary center from a secondary-level ED without PCI capability. SVEAT and HEART scores were calculated at presentation, and patients were followed for 30 days to identify MACE. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance, and a DeLong test was applied for statistical comparison of the two scores. RESULTS: Among 230 referred patients, 158 (68.7%) did not experience MACE. The SVEAT score demonstrated a higher area under the ROC curve (AUC:0.969; 95% CI:0.946-0.991) than the HEART score (AUC:0.948;95% CI:0.917-0.979) (p = 0.0457). While the HEART score had higher sensitivity (88.9%), the SVEAT score showed greater specificity (98.1%) and a superior positive predictive value (95.1% vs. 77.1%). Overall diagnostic accuracy was higher for the SVEAT score (92.6%). CONCLUSION: Both the SVEAT and HEART scores are effective tools for predicting MACE in chest pain patients without STEMI in non-PCI EDs. However, the SVEAT score offers greater specificity and accuracy, supporting more individualized referral decisions in low-risk patients when used together with clinical judgment.