We evaluated the ability of a stress-test (Str-T) to improve the risk stratification based on prognostic scores in patients pre - senting to the ED with chest pain. Between 2008, June and 2013, December, 1082 patients with chest pain were evaluated with an imaging Str-T. With a retrospective analysis, patients were stratified according to: (1) Florence Prediction Rule as low (0–1, LR-FPR), intermediate (2–4, IR-FPR), high risk (5–6, HR-FPR), respectively, 26, 50 and 24% of patients; (2) HEART score as LR-HEART, (0–3) and HR-HEART (≥4), respectively, 36 and 64%; (3) likelihood of CAD according to NICE guidelines, 10–29% LR-NICE, 30–60% IR-NICE and > 60% HR-NICE, respectively, 12, 18 and 70%. Scores’ diagnostic performance was calculated with Str-T as reference. One-month follow-up by a phone call was performed, to investigate the occurrence of new cardiovascular events. In LR and HR patients, FPR and NICE score showed sensitivity 66 vs 93%, speci- ficity 59 vs 19% (both p < 0.001), Positive Predictive Value (PPV) 36 vs 31%, Negative Predictive Value (NPV) 83 vs 87%. Among LR-HEART patients, Str-T was positive for inducible ischemia in 53 (14%) patients and 12 (4%) of them underwent a percutaneous coronary revascularization. The Str-T was negative for inducible
Internal and Emergency Medicine – Springer Journals
Published: May 29, 2018
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