Wibring et al reported models for evaluating patients with chest pain. One model predicts high-risk chest pain while a second predicts low-risk chest pain. The authors are from multiple institutions in Sweden.
Patient selection: chest pain
Parameters:
(1) age in years
(2) sex
(3) previous history of heart failure
(4) previous history of kidney failure
(5) previous history of atrial fibrillation or flutter
(6) prehospital serum troponin T in ng/L
(7) ST depression in ECG
(8) pallor
(9) pain onset during activity
(10) constant pain
(11) pain in right arm
(12) pressuring pain
|
Parameter |
Finding |
OR |
beta-coefficient (LN OR) |
|
age in years |
|
1.03 |
0.0296 * (age) |
|
sex |
female |
1 |
0 |
|
|
male |
1.58 |
0.457 |
|
history heart failure |
no |
1 |
0 |
|
|
yes |
0.54 |
-0.616 |
|
history kidney disease |
no |
1 |
0 |
|
|
yes |
0.42 |
-0.868 |
|
atrial fib/flutter |
no |
1 |
0 |
|
|
yes |
0.31 |
-1.17 |
|
serum troponin |
< 40 ng/L |
1 |
0 |
|
|
40 to 100 ng/L |
5.68 |
1.74 |
|
|
101-1000 ng/L |
18.13 |
2.90 |
|
|
> 1,000 ng/L |
41.21 |
3.72 |
|
ST depression |
no |
1 |
0 |
|
|
yes |
3.81 |
1.34 |
|
pallor |
no |
1 |
0 |
|
|
yes |
2.02 |
0.703 |
|
pain during activity |
no |
1 |
0 |
|
|
yes |
2.31 |
0.837 |
|
constant pain |
no |
1 |
0 |
|
|
yes |
1.85 |
0.615 |
|
pain right arm |
no |
1 |
0 |
|
|
yes |
3.02 |
1.105 |
|
pressuring pain |
no |
1 |
0 |
|
|
yes |
1.55 |
0.438 |
|
constant |
|
0.01 |
-4.605 |
value of X =
= SUM(beta-coefficients)
probability of high-risk chest pain =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.85.
Specialty: Cardiology
