Key result
The SVEAT score predicted 30-day major adverse cardiovascular events with an AUC of 0.843, but a cut-off of 3.5 yielded a sensitivity of only 63.2%, missing approximately one-third of events.
Why the study?
Existing chest pain risk scores inadequately identify low-risk patients for safe early discharge, and initial clinical data are often underutilized.
Does the SVEAT score improve the prediction of 30-day MACE in patients with acute-onset chest pain compared to HEART and TIMI scores?
Observational (n=60)
No
Does the SVEAT score improve the prediction of 30-day MACE in patients with acute-onset chest pain compared to HEART and TIMI scores?
The SVEAT score lacks sufficient sensitivity compared to the HEART score for predicting 30-day MACE in patients presenting with acute chest pain, suggesting it needs re-evaluation before routine clinical use.
Answers are grounded in this paper and cite their sources.
SVEAT may lack sensitivity for safe early discharge; leaves open need for prospective validation before clinical use.
Introduction Acute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. Methodology This prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi, Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. Results A total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. Conclusion SVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.
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Shahid et al. (2023) conducted an observational in Acute-onset chest pain (n=60). SVEAT score vs. HEART and TIMI scores was evaluated on 30-day major adverse cardiovascular events (MACE) (AUC 0.843, 95% CI 0.74-0.94). The SVEAT score predicted 30-day major adverse cardiovascular events with an AUC of 0.843, but a cut-off of 3.5 yielded a sensitivity of only 63.2%, missing approximately one-third of events.
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