Key result
The CORE score identified 33% of emergency department chest pain patients as low risk, ruling out 30-day MACE with a negative predictive value of 99.6% (95% CI 97.4-100).
Why the study?
Does the CORE score accurately identify low-risk emergency department patients with chest pain to exclude 30-day MACE?
Cohort (n=751)
Does the CORE score accurately identify low-risk emergency department patients with chest pain to exclude 30-day MACE?
The CORE score, utilizing hs-cTnT and four simple clinical variables, safely identifies one-third of ED chest pain patients for potential early discharge with a 99.6% negative predictive value for 30-day MACE.
May support early discharge for low-risk ED chest pain; leaves open need for prospective validation before practice change.
OBJECTIVES: Chest pain is a common complaint in the emergency department (ED), and it is a challenge to identify low-risk chest pain patients eligible for early discharge. We aimed to develop a simple objective decision rule to exclude 30-day major adverse cardiac events (MACE) in ED chest pain patients. DESIGN: We analyzed prospectively included patients presenting with chest pain. Low risk patients were identified with the clinical objective rule-out evaluation (CORE). CORE was based on high sensitivity cardiac troponin T (hs-cTnT) tests at ED presentation (0 h) and 2 h later together with a simplified risk score consisting of four objective variables: age ≥65 years and a history of arterial disease, hypertension or diabetes. For the patient to be classified as low risk in the CORE rule, hs-cTnT had to be ≤14 ng/L both at 0 and 2 h, and the sum of the risk score had to be 0. The primary outcome was MACE within 30 days. RESULTS: Among the 751 patients in the final analysis, 90 (11.9%) had a MACE. CORE identified 248 (33%) of patients as low risk with a sensitivity of 98.9% (CI 93.1-99.9) and a negative predictive value of 99.6% (95% CI 97.4-100) for 30-day MACE. Adding the ED physician's interpretation of the ECG to CORE did not improve diagnostic performance. CONCLUSION: A simple objective decision rule (CORE) identified one-third of all patients as having a very low 30-day risk of MACE. These patients may potentially be discharged without additional investigations for acute coronary syndrome.
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Borna et al. (2018) conducted a cohort in Acute chest pain (n=751). Clinical objective rule-out evaluation (CORE) score was evaluated on MACE within 30 days (NPV 99.6%, 95% CI 97.4-100). The CORE score identified 33% of emergency department chest pain patients as low risk, ruling out 30-day MACE with a negative predictive value of 99.6% (95% CI 97.4-100).
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