Ngako et al evaluated older adults in the Emergency Department with symptoms suspicious for acute coronary syndrome. They developed a score which can help to distinguish low from high risk patients. The authors are from Groupe Hospitalier Henri Mondor-Albert Chenevier and Universite Paris 12 in Creteil, France.
Patient selection: age >= 65 years with symptoms suspicious for acute coronary syndrome (ACS)
Parameters:
(1) gender
(3) history of coronary artery disease (CAD)
(4) pathologic Q wave
(5) epigastric pain
(6) ST segment elevation
(7) typical chest pain
(8) typical left arm, jaw and neck pain
|
Parameter |
Finding |
Points |
|
gender |
female |
0 |
|
|
male |
1 |
|
dyspnea |
absent |
0 |
|
|
present |
1 |
|
history of CAD |
absent |
0 |
|
|
present |
2 |
|
pathologic Q wave |
absent |
0 |
|
|
present |
2 |
|
epigastric pain |
absent |
0 |
|
|
present |
2 |
|
ST segment elevation |
absent |
0 |
|
|
present |
2 |
|
typical chest pain |
absent |
0 |
|
|
present |
3 |
|
typical left arm, jaw and neck pain |
absent |
0 |
|
|
present |
3 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score 16
• The higher the score the greater the risk for acute coronary syndrome (ACS).
• A patient can be classified using the Heart Attack Risk for aged Patient (HARP) categories.
|
Total Score |
HARP Group |
ACS |
|
0 |
I |
0% |
|
1 or 2 |
II |
16% |
|
3 to 5 |
III |
33% |
|
>= 6 |
IV |
70% |
Performance:
• The area under the ROC curve was 0.79.
Specialty: Cardiology
