Bosner et al developed a simple rule for predicting coronary artery disease (CAD) in a primary care patient with chest pain. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Marburg, University of Lausanne and Paracelsus University (Salzburg).
Patient selection: primary care patient with chest pain
Parameters:
(1) age and gender
(2) known clinical vascular disease (coronary artery disease, occlusive vascular disease, cerebrovascular disease)
(3) chest pain during exercise exercise
(4) chest pain during palpation
(5) patient's opinion about source of chest pain
|
Parameter |
Finding |
Points |
|
age and gender |
female and < 65 years |
0 |
|
|
female and >= 65 years |
1 |
|
|
male and < 55 years |
0 |
|
|
male and >= 55 years |
1 |
|
known vascular disease |
no |
0 |
|
|
yes |
1 |
|
chest pain during exercise |
not worse |
0 |
|
|
worse |
1 |
|
chest pain during palpation |
reproduced |
0 |
|
|
not reproduced |
1 |
|
patient's opinion about pain |
related to heart |
1 |
|
|
other origin |
0 |
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the risk of myocardial ischemia.
• A score >= 3 was used to identify a patient to refer for management.
Performance:
• The cutoff >= 3 had a sensitivity of 87% and specificity of 81%.
• The negative predictive value was 0.87 to 0.90.
• The negative predictive value was 98%.
Purpose: To identify a primary care patient with chest pain who may have coronary artery disease using the prediction rule of Bosner et al.
Specialty: Cardiology
Objective: criteria for diagnosis
ICD-10: I20.9, R07.1, R07.3, R07.4,
