Why the study?
Patients with suspected NSTE-ACS in the observe zone of the ESC 0/1-h algorithm are heterogeneous with an unfavourable prognosis, prompting a model to predict a coronary diagnosis at index presentation.
Can a clinical risk score identify patients in the ESC 0/1-h algorithm 'observe' zone at low risk of a coronary diagnosis?
Cohort (n=750)
No
Can a clinical risk score identify patients in the ESC 0/1-h algorithm 'observe' zone at low risk of a coronary diagnosis?
Effect estimate: c-statistic 0.78 (95% CI 0.74-0.82)
A novel 12-point risk score can effectively identify ED patients in the ESC 0/1-h algorithm 'observe' zone who are at low risk for a coronary event, aiding in diagnostic decision-making.
May aid observe-zone triage without changing practice; leaves open prospective validation before adoption.
BACKGROUND: Patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) assigned to the "observe" zone of the European Society of Cardiology (ESC) 0/1-h algorithm form a heterogeneous group known to have an unfavourable prognosis. We aim to elucidate the clinical characteristics and management of these patients and generate a model that is predictive of a coronary diagnosis at index visit to the emergency department (ED). METHODS: A retrospective observational cohort study, including adult patients presenting to the ED with suspected NSTE-ACS assigned to the "observe" zone of the ESC 0/1-h algorithm. Multivariable logistic regression analysis was performed for the prediction of a coronary diagnosis. Internal validation was performed using bootstrap resampling. RESULTS: A total of 750 patients were included; mean age 66 ± 13 years, 35% women, 50% with prior history of coronary artery disease (CAD). In 372 (50%) patients a diagnosis was established within 30 days of index presentation, of whom 169 (45%) patients had a coronary-related event. Multivariable logistic regression analysis generated a 12-point risk score incorporating 5 variables for the prediction of such event, including type of angina, chest pain occurring during inspiration, prior history of CAD, ST-segment deviation on electrocardiogram, and estimated glomerular filtration rate <60. The final model had an optimism-corrected c-statistic of 0.78 (95% confidence interval [CI]: 0.74-0.82). A score <6 ruled out a coronary event in 276 (37%) patients, with a sensitivity and negative predictive value of 90% (95% CI: 84-94) and 94% (91-96), respectively. CONCLUSION: A score <6 identifies patients at low risk of a coronary diagnosis and can guide clinical decision-making in choosing the appropriate diagnostic test.
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Arslan et al. (2022) conducted a cohort in Suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) (n=750). PEKT score was evaluated on Coronary diagnosis at index visit to the ED (established within 30 days) (c-statistic 0.78, 95% CI 0.74-0.82).
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