Open Access Emergency Medicine (Feb 2024)
Chest Pain Risk Stratification in the Emergency Department: Current Perspectives
Abstract
Zeynep Yukselen,1 Vidit Majmundar,1 Mahati Dasari,1 Pramukh Arun Kumar,1 Yuvaraj Singh2 1Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA; 2Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, MA, 01605, USACorrespondence: Yuvaraj Singh, Division of Gastroenterology and Hepatology, UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, 01605, USA, Tel +1 774-641-7648 ; +1 508-334-4297, Email [email protected]: Chest pain is the second leading cause of all emergency department (ED) visits in adults in the United States, with nearly 11 million encounters yearly. While identifying low-risk patients is crucial for early discharge, identifying high-risk patients in ED is vital in timely and appropriate acute coronary syndrome (ACS) management. Traditional methods such as physical examination, cardiac markers, or imaging tests cannot reliably confirm or rule out ACS; they cannot be singularly incorporated to risk stratify patients. Various clinical risk scores have been proposed to address this challenge for risk stratification in patients being evaluated for suspected ACS. The ideal risk score should demonstrate high sensitivity and specificity to accurately differentiate between patients with varying levels of risk, particularly in identifying those at high risk for major adverse cardiovascular events. Simultaneously, an ideal scoring system should also be able to compute information for other non-coronary etiologies of chest pain that require time-sensitive interventions and workups (eg, aortic dissection and pulmonary embolism). In this review, we have assembled major risk scores used for risk stratification in patients with acute chest pain in ED. We have abbreviated their salient features to assist readers in their clinical decision-making.Keywords: angina, acute coronary syndrome, ED, cardiac mortality, adverse events
