Conti et al developed a clinical rule for evaluating a patient with acute chest pain but no known history of coronary artery disease. This can help to identify a patient who should undergo a cardiac workup. The authors are from Careggi University in Florence, Italy.
Patient selection: acute chest pain and no known history of coronary artery disease
Endpoints: death, acute myocardial infarction and/or urgent coronary revascularization
Parameters:
(1) location of chest pain
(2) radiation of chest pain
(3) character of the chest pain
(4) associated symptoms
(5) past history of chest pain
|
Parameter |
Finding |
Points |
|---|---|---|
|
location of chest pain |
substernal or precordial |
3 |
|
|
left chest, neck, lower jaw, or epigastrium |
1 |
|
|
other |
0 |
|
radiation |
left arm or shoulder, right arm or shoulder, back, neck, lower jaw |
1 |
|
|
other |
0 |
|
|
none |
0 |
|
character |
crushing, pressing, heaviness |
3 |
|
|
sticking, pleuritic, pinprick |
1 |
|
|
other |
0 |
|
associated symptoms |
dyspnea, nausea, diaphoresis |
2 |
|
|
other |
0 |
|
|
none |
0 |
|
previous history of chest pain |
no |
0 |
|
|
yes |
3 |
chest pain score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum chest pain score: 0
• maximum chest pain score: 12
• The higher the score the greater the risk of coronary artery disease.
• A score > 6 was used in a clinical rule (below).
Parameters for clinical rule:
(1) score for chest pain score
(2) gender
(3) age in years
(4) metabolic syndrome
(5) diabetes mellitus
|
Parameter |
Finding |
Points |
|---|---|---|
|
chest pain score |
0 to 6 |
0 |
|
|
> 6 |
3 |
|
gender |
male |
1 |
|
|
female |
0 |
|
age |
<= 50 years |
0 |
|
|
> 50 years |
1 |
|
metabolic syndrome |
no |
0 |
|
|
yes |
1 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
1 |
score for clinical rule =
= SUM(points for all 5 parameters)
Interpretation of clinical rule:
• minimum score for rule: 0
• maximum score for rule: 7
• The higher the score for the clinical rule the greater the likelihood of coronary artery disease.
|
Rule |
Group |
Risk for Endpoint |
|---|---|---|
|
0 or 1 |
A |
low |
|
2 to 4 |
B |
intermediate |
|
>= 5 |
C |
high |
Specialty: Cardiology
ICD-10: ,
