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CLINICAL RESEARCH: MYOCARDIAL INFARCTION/ISCHEMIA

New Risk Score for Patients With Acute Chest Pain, Non-ST-Segment Deviation, and Normal Troponin Concentrations

A Comparison With the TIMI Risk Score

Juan Sanchis, MD^_*,_*, Vicent Bodí, MD^_*, Julio Núñez, MD^_*, Vicente Bertomeu-González, MD^_*, Cristina Gómez^_*, María José Bosch, MD^_*, Luciano Consuegra, MD^_*, Xavier Bosch, MD, Francisco J. Chorro, MD^_* and Àngel Llàcer, MD^_*

^_* Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain
Institut Clínic de Malalties Cardiovasculars. Hospital Clínic, Barcelona, Spain.

Manuscript received March 4, 2005; revised manuscript received March 29, 2005, accepted April 13, 2005.

^_* Reprint requests and correspondence: Dr. Juan Sanchis Forés, Servei de Cardiologia, Hospital Clínic Universitari, Blasco Ibáñez 17, 46010 València, Spain. (Email: sanchis_juafor{at}gva.es).

OBJECTIVES: The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels.

BACKGROUND: Prognosis assessment in this population remains a challenge.

METHODS: A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain characteristics), ECG, and early exercise testing. ST-segment deviation and troponin elevation were exclusion criteria. The primary end point was mortality or myocardial infarction at one year. The secondary end point was mortality, myocardial infarction, or urgent revascularization at 14 days (similar to the Thrombolysis In Myocardial Infarction [TIMI] risk score).

RESULTS: Primary and secondary end point rates were 6.7% and 5.4%. A risk score was constructed using the variables related to the primary end point: chest pain score 10 points (hazard ratio [HR] = 2.5; 1 point), 2 pain episodes in last 24 h (HR = 2.2; 1 point), age 67 years (HR = 2.3; 1 point), insulin-dependent diabetes mellitus (HR = 4.2; 2 points), and prior percutaneous transluminal coronary angioplasty (HR = 2.2; 1 point). Patients were classified into five categories of risk (p = 0.0001): 0 points, 0% event rate; 1 point, 3.1%; 2 points, 5.4%; 3 points, 17.6%; 4 points, 29.6%. The accuracy of the score was greater than that of the TIMI risk score for the primary (C index of 0.78 vs. 0.66, p = 0.0002) and secondary (C index of 0.70 vs. 0.66, p = 0.1) end points.

CONCLUSIONS: Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CABG = coronary artery bypass graft   CI = confidence interval   HR = hazard ratio   IDDM = insulin-dependent diabetes mellitus   PTCA = percutaneous transluminal coronary angioplasty   ROC = receiver-operating characteristic   TIMI = Thrombolysis In Myocardial Infarction

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