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Risk Stratification in Chest Pain Patients Undergoing Nuclear Stress Testing: The Erlanger Stress Score.
MedLine Citation:
PMID:  23149358     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Studies have individually reported the relationship of age, cardiac risk factors, and history of preexisting coronary artery disease (CAD) for predicting acute coronary syndromes in chest pain patients undergoing cardiac stress testing. In this study, we investigate the interplay of all these factors on the incidence of acute coronary syndromes to develop a tool that may assist physicians in the selection of appropriate chest pain patients for stress testing. METHODS:: Retrospective analysis of a prospectively acquired database of consecutive chest pain patients undergoing nuclear stress testing. Backward stepwise logistic regression was used to develop a model for predicting risk of 30-day acute coronary events (ACE) using information obtained from age, sex, cardiac risk factors, and history of preexisting CAD. RESULTS:: A total of 800 chest pain patients underwent nuclear stress testing. ACE occurred in 74 patients (9.3%). Logistic regression analysis found only 6 factors predictive of ACE: age, male sex, preexisting CAD, diabetes, and hyperlipidemia. Area under the receiver operator characteristic curve of this model for predicting ACE was 0.767 (95% confidence interval, 0.719-0.815). There were no cases of ACE in the 173 patients with predicted probability estimates ≤2.5% (95% confidence interval, 0%-2.1%). CONCLUSIONS:: A regression model using age, sex, preexisting CAD, diabetes, and hyperlipidemia is predictive of 30-day ACE in chest pain patients undergoing nuclear stress testing. Prospective studies need to be performed to determine whether this model can assist physicians in the selection of appropriate low-to-intermediate risk chest pain patients for nuclear stress testing.
Authors:
Francis M Fesmire; Ron C Buchheit; Yu Cao; Harry W Severance; Yi Jang; Gregory W Heath
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Critical pathways in cardiology     Volume:  11     ISSN:  1535-2811     ISO Abbreviation:  Crit Pathw Cardiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101165286     Medline TA:  Crit Pathw Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  171-176     Citation Subset:  -    
Affiliation:
From the *Department of Emergency Medicine, University of Tennessee College of Medicine-Chattanooga, Erlanger Medical Center, Chattanooga, TN; †College of Engineering and Computer Science, University of Tennessee Chattanooga, Chattanooga, TN; and ‡Department of Medicine, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN.
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