Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score.

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State: Public
Version: Final published version
Serval ID
serval:BIB_80396E68F6CD
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score.
Journal
BMC medicine
Author(s)
Gencer B., Vaucher P., Herzig L., Verdon F., Ruffieux C., Bösner S., Burnand B., Bischoff T., Donner-Banzhoff N., Favrat B.
ISSN
1741-7015 (Electronic)
ISSN-L
1741-7015
Publication state
Published
Issued date
21/01/2010
Peer-reviewed
Oui
Volume
8
Pages
9
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
Chest pain raises concern for the possibility of coronary heart disease. Scoring methods have been developed to identify coronary heart disease in emergency settings, but not in primary care.
Data were collected from a multicenter Swiss clinical cohort study including 672 consecutive patients with chest pain, who had visited one of 59 family practitioners' offices. Using delayed diagnosis we derived a prediction rule to rule out coronary heart disease by means of a logistic regression model. Known cardiovascular risk factors, pain characteristics, and physical signs associated with coronary heart disease were explored to develop a clinical score. Patients diagnosed with angina or acute myocardial infarction within the year following their initial visit comprised the coronary heart disease group.
The coronary heart disease score was derived from eight variables: age, gender, duration of chest pain from 1 to 60 minutes, substernal chest pain location, pain increasing with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the receiver operating characteristics curve was of 0.95 with a 95% confidence interval of 0.92; 0.97. From this score, 413 patients were considered as low risk for values of percentile 5 of the coronary heart disease patients. Internal validity was confirmed by bootstrapping. External validation using data from a German cohort (Marburg, n = 774) revealed a receiver operating characteristics curve of 0.75 (95% confidence interval, 0.72; 0.81) with a sensitivity of 85.6% and a specificity of 47.2%.
This score, based only on history and physical examination, is a complementary tool for ruling out coronary heart disease in primary care patients complaining of chest pain.

Keywords
Adult, Aged, Area Under Curve, Chest Pain/diagnosis, Chest Pain/etiology, Cohort Studies, Coronary Disease/diagnosis, Diagnosis, Differential, Electrocardiography, Female, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Predictive Value of Tests, Primary Health Care/methods, ROC Curve, Reproducibility of Results, Risk Factors
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2010 14:37
Last modification date
20/08/2019 14:40
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