Predictive Instrument of Wei et al for Evaluating a Patient in the Emergency Room with Chest Pain

Patient selection: ED patient with chest pain lasting at least 30 minutes AND without ST segment elevation in the ECG

Outcome: nonfatal AMI (defined by elevated serum troponin) or cardiac-related death

Parameters:

(1) ECG normal vs abnormal

(2) ST-T changes

(3) regional function (RF) and myocardial perfusion (MP) by contrast echocardiography using a 14-segment myocardial model divided into 3 coronary teritories

where:

• ST changes abnormal indicate depression since elevation excluded. If ST changes present, then the ECG would be classed as abnormal.

• The option of RF normal and MP abnormal was not presented.

• Myocardial perfusion was abnormal if maximal myocardial opacification was not seen within a segment by 5 cardiac cycles.

• Abnormal regional function consisted of akinesia, hypokinesia or dyskinesia.

total score =

= SUM(points for all 3 parameters)

Interpretation:

• minimum score: 0

• maximum score: 4

• A patient with a score of 0 may be able to be discharged.

• The higher the score the greater the chance of cardiac event.

Limitation:

• The study needs to be confirmed in a multicenter study.