The objective CORE score allows early rule out in acute chest pain patients.
OBJECTIVES
Chest pain is a common complaint in the emergency department (ED), and it is a challenge to identify low-risk chest pain patients eligible for early discharge. We aimed to develop a simple objective decision rule to exclude 30-day major adverse cardiac events (MACE) in ED chest pain patients.


DESIGN
We analyzed prospectively included patients presenting with chest pain. Low risk patients were identified with the clinical objective rule-out evaluation (CORE). CORE was based on high sensitivity cardiac troponin T (hs-cTnT) tests at ED presentation (0 h) and 2 h later together with a simplified risk score consisting of four objective variables: age ≥65 years and a history of arterial disease, hypertension or diabetes. For the patient to be classified as low risk in the CORE rule, hs-cTnT had to be ≤14 ng/L both at 0 and 2 h, and the sum of the risk score had to be 0. The primary outcome was MACE within 30 days.


RESULTS
Among the 751 patients in the final analysis, 90 (11.9%) had a MACE. CORE identified 248 (33%) of patients as low risk with a sensitivity of 98.9% (CI 93.1-99.9) and a negative predictive value of 99.6% (95% CI 97.4-100) for 30-day MACE. Adding the ED physician's interpretation of the ECG to CORE did not improve diagnostic performance.


CONCLUSION
A simple objective decision rule (CORE) identified one-third of all patients as having a very low 30-day risk of MACE. These patients may potentially be discharged without additional investigations for acute coronary syndrome.
['Borna|Catharina|C|', 'Kollberg|Knut|K|', 'Larsson|David|D|', 'Mokhtari|Arash|A|', 'Ekelund|Ulf|U|']
D054058:Acute Coronary Syndrome D000293:Adolescent D000328:Adult D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000787:Angina Pectoris D015415:Biomarkers D015897:Comorbidity D003661:Decision Support Techniques D042241:Early Diagnosis D004562:Electrocardiography D004636:Emergency Service, Hospital D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010351:Patient Discharge D011237:Predictive Value of Tests D011379:Prognosis D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D013548:Sweden D013997:Time Factors D020107:Troponin T D055815:Young Adult
early rule out chest pain acute coronary syndrome high sensitivity troponin T major cardiac event