Risk scales in the diagnosis of unstable angina in patients with chest pain with negative electrocardiogram and biomarkers

Escalas de riesgo en el diagnóstico de la angina inestable en pacientes con dolor torácico con electrocardiograma y biomarcadores negativos

Introduction: The evaluation of chest pain in cases where electrocardiogram and biomarkers are negative represent a challenge for the clinician. Severe scales are now being used as an additional strategy for the prognosis stratification. The objective of the present study is to describe the diagnostic performance of the diagnostic scales for acute coronary symptoms in patients with high probability and in whom the electrocardiogram and biomarkers are negative.
Methodology: A study of the diagnostic tests in a cohort of patients older than 18 years old, who were admitted into 2 level-3 hospitals due to chest pain and suspicion of acute coronary syndrome with no changes in the electrocardiogram or increases in biomarkers. Different coronary stratification tests were used as a diagnostic reference, and the different scales for evaluating the prognosis in chest pain were included for the index test. The operational characteristics were calculated for different cut-off points, and the areas under the ROC curve were compared.
Results: The study included a total of 86 patients. The mean age was 63 years old, with 61.6% men, and 51.2% of the patients had a diagnosis of angina. The HEART scale gave a better performance, with an area under the curve of 0.65, followed by the GRACE scale with 0.61. The confidence intervals overlapped the different evaluation scales.
Conclusion: The scales of risk prediction in patients with chest pain, evaluated for diagnostic purposes, showed a lower discriminatory power in a population of patients with high risk, despite having a negative electrocardiogram and troponin.

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