Limitations of risk score models in patients with acute chest pain - 13/08/11
on behalf of the Rule-Out Myocardial Infarction using Coronary Artery Tomography (ROMICAT) Study Investigators
Abstract |
Objectives |
Cardiac multidetector computed tomography (CMCT) has potential to be used as a screening test for patients with acute chest pain, but several tools are already used to risk-stratify this population. Risk models exist that stratify need for intensive care (Goldman), short-term prognosis (Thrombolysis in Myocardial Infarction, TIMI), and 1-year events (Sanchis). We applied these cardiovascular risk models to candidates for CMCT and assessed sensitivity for prediction of in-hospital acute coronary syndrome (ACS). We hypothesized that none of the models would achieve a sensitivity of 90% or greater, thereby justifying use of CMCT in patients with acute chest pain.
Methods |
We analyzed TIMI, Goldman, and Sanchis in 148 consecutive patients with chest pain, nondiagnostic electrocardiogram, and negative initial cardiac biomarkers who previously met inclusion and exclusion criteria for the Rule-Out Myocardial Infarction Using Coronary Artery Tomography Study. ACS was adjudicated, and risk scores were categorized based on established criteria. Risk score agreement was assessed with weighted κ statistics.
Results |
Overall, 17 (11%) of 148 patients had ACS. For all risk models, sensitivity was poor (range, 35%-53%), and 95% confidence intervals did not cross above 77%. Agreement to risk-classify patients was poor to moderate (weighted κ range, 0.18-0.43). Patients categorized as “low risk” had nonzero rates of ACS using all 3 scoring models (range, 8%-9%).
Conclusions |
Available risk scores had poor sensitivity to detect ACS in patients with acute chest pain. Because of the small number of patients in this data set, these findings require confirmation in larger studies.
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☆ | Abstract presented at the Society of Academic Emergency Medicine Annual Meeting, Chicago, Ill, May 19, 2007. |
☆☆ | Funding: Supported by National Institutes of Health R01 grant HL080053 (Principal Investigator: Dr. Hoffmann) and a Departmental Award from the Massachusetts General Hospital Department of Emergency Medicine (Principal Investigator: Dr. Manini). |
Vol 27 - N° 1
P. 43-48 - janvier 2009 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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