A novel score to stratify risk associated with acute chest pain, the SVEAT (Symptoms, Vascular disease history, Electrocardiography, Age, and Troponin level) score, was found to outperform 2 commonly used scoring systems in predicting the 30-day risk for major adverse cardiovascular events (MACE), according to study results published in the American Journal of Cardiology.
Acute chest pain is one of the most frequent symptoms of patients presenting to the emergency department (ED). Risk stratification based on all readily available and pertinent clinical data to accurately identify patients at low risk who can safely be discharged early is essential. However, current risk scores, such as the HEART (History, Electrocardiogram [ECG], Age, Risk factors, and Troponin level) score or the thrombolysis in myocardial infarction (TIMI) score may not be optimal.
In this single-center, prospective, observational study (ClinicalTrials.gov Identifier: NCT03511430), 321 patients with acute chest pain (≥25 years; mean age, 58.7±12.8 years; 51.4% men) who presented to the ED between May 2017 and August 2018 were enrolled and followed.
The study’s primary outcome was the 30-day incidence of MACE (acute myocardial infarction, newly diagnosed coronary artery disease treated pharmacologically, percutaneous coronary intervention, coronary artery bypass grafting, or death). All participants were assessed using the novel 5-component SVEAT, the HEART, and the TIMI scores. Results were compared for the ability of each scoring system to predict the occurrence of MACE and identify patients at low risk, by calculating the area under the curve (AUC) of the receiver-operator characteristic curve.
The 30-day MACE incidence was 19.6% (n=63) in the cohort. A greater percentage of patients who experienced vs did not have MACE within 30 days were men (78% vs 45%, respectively; P =.001), had dyslipidemia (73% vs 48%, respectively; P =.001), diabetes mellitus 44% vs 23%, respectively; P =.001), and hypertension (76% vs 57%, respectively; P =.006).
The SVEAT score had a greater AUC (0.982; 95% CI, 0.971-0.994) compared with the HEART (0.921; 95% CI, 0.883-0.959) or TIMI (0.884; 95% CI, 0.838-0.930) scores, indicating better short-term prognostic ability.
When a SVEAT score of 4 was used as a cutoff for low-risk classification, 0.8% of patients classified as being at low-risk developed MACE over 30 days, compared with 1.4% and 1.5% using the HEART and TIMI scores, respectively. The SVEAT scoring system led to the identification of a greater percentage of patients as being at low risk compared with the HEART and TIMI scores (73.8% vs 45.2% and 40.1%, respectively; P <.01 for both).
Study limitations include its single-center setup, and small sample size.
“Utilizing SVEAT score in routine clinical assessment of these patients may help identify the majority of individuals who are eligible for safe and early discharge from the emergency department,” noted the authors.
Roongsritong C, M MET, Pisipati S, et al. SVEAT score, a potential new and improved tool for acute chest pain risk stratification. Am J Cardiol. April 2020. doi:10.1016/j.amjcard.2020.04.009