New risk score predicts heart disease in patients with chest pain

June 12, 2012

A new risk prediction tool can identify patients at high risk of coronary artery disease who might need further diagnostic work, says a study published on BMJ today. The tool is more accurate than existing models and could be easily integrated into electronic patient records or mobile applications.

Coronary artery disease is a major cause of death throughout the world. It occurs when the arteries supplying oxygen and nutrients to the heart become narrowed with .

Chest pain may be the first sign of the condition so current guidelines recommend using one of two (the Diamond & Forrester model or the Duke Clinical Score) for patients with chest pain to help doctors estimate their risk and decide if further tests are needed.

However, questions about the accuracy of these tools have been raised.

So a team of European researchers decided to develop an improved prediction model using a range of variables with known links to coronary artery disease. They analysed data for 5,677 patients (3,283 men and 2,394 women) with chest pain but no previous history of heart disease from 18 hospitals across Europe and the USA.

Their basic model predicted coronary artery disease according to age, sex and symptoms. A clinical model included risk factors such as diabetes, high blood pressure, elevated lipid levels and smoking, while an extended model added the coronary calcium score (a measure of calcium in the coronary arteries that is associated with the presence of coronary artery disease and also determines the risk of a coronary event).

Their results suggest that the Duke Clinical Score (the tool that is currently recommended by the NICE guideline) significantly overestimates the probability of coronary artery disease.

Their clinical model improves these estimates, predicting probabilities between 2% for a 50 year old female with non-specific chest pain and no risk factors and 91% for an 80 year old male with typical chest pain and multiple risk factors.

Adding the coronary calcium score improved the prediction event further.

In addition, their model does not require resting heart (ECG) readings, making it better suited for use in primary practice, while an online calculator, also developed by the team, could be easily integrated into or .

Because the implementation of the NICE guidelines requires an accurate estimate of the probability of , the authors conclude that their model "allows doctors to make better decisions as to which diagnostic test is best in a particular patient and to decide on further management based on the results of such tests."

Related Stories

Recommended for you

How genes and environment interact to raise risk of congenital heart defects

October 19, 2017
Infants of mothers with diabetes have a three- to five-fold increased risk of congenital heart defects. Such developmental defects are likely caused by a combination of genetic and environmental factors. However, the molecular ...

Mouse studies shed light on how protein controls heart failure

October 18, 2017
A new study on two specially bred strains of mice has illuminated how abnormal addition of the chemical phosphate to a specific heart muscle protein may sabotage the way the protein behaves in a cell, and may damage the way ...

Newborns with trisomy 13 or 18 benefit from heart surgery, study finds

October 18, 2017
Heart surgery significantly decreases in-hospital mortality among infants with either of two genetic disorders that cause severe physical and intellectual disabilities, according to a new study by a researcher at the Stanford ...

Saving hearts after heart attacks: Overexpression of a gene enhances repair of dead muscle

October 17, 2017
University of Alabama at Birmingham biomedical engineers report a significant advance in efforts to repair a damaged heart after a heart attack, using grafted heart-muscle cells to create a repair patch. The key was overexpressing ...

Physically active white men at high risk for plaque buildup in arteries

October 17, 2017
White men who exercise at high levels are 86 percent more likely than people who exercise at low levels to experience a buildup of plaque in the heart arteries by middle age, a new study suggests.

High blood pressure linked to common heart valve disorder

October 17, 2017
For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health at the University ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.