Ordinal Coronary Artery Calcification Score: Acute Chest Pain Risk Stratification in the Emergency Department

Aim: Chest pain is one of the most common reasons for visiting the emergency department (ED). This study aimed to determine the diagnostic performance of the simple Ordinal Score in predicting 30-day major adverse cardiac events (MACE) in adult patients presenting to the ED with chest pain.Material and Methods: This single-center, cross-sectional study was conducted at the ED of a tertiary teaching and research hospital. All patients who presented with chest pain who did not meet the exclusion criteria were included. The simple Ordinal score was independently assessed on thorax computed tomography (CT) scans. The effectiveness of the simple Ordinal score in predicting MACE was evaluated using a receiver operating characteristic (ROC) curve analysis and diagnostic test characteristics.Results: Forty-nine patients were included in the study. MACE occurred in 10 patients but not in the remaining 39 patients. The area under the curve (AUC) for the simple Ordinal score assessed by the emergency medicine specialist (EMS) was 0.913, and the cut-off value was (≥ 4), with a sensitivity of 90.0% (95% CI, 55.5% - 99.8%) and a specificity of 74.4% (95% CI, 57.9% - 87.0%). The AUC for the simple Ordinal score by the radiologist was 0.921, and the cut-off value was (≥ 4), with a sensitivity of 90.0% (95% CI, 55.5% - 99.8%) and a specificity of 84.6% (95% CI, 69.5% - 94.1%).Conclusion: The simple Ordinal score, assessed by an EMS on thorax CT, has high sensitivity and moderate specificity for detecting MACE in patients with chest pain.