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Published in: BMC Medicine 1/2010

Open Access 01-12-2010 | Research article

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

Authors: Baris Gencer, Paul Vaucher, Lilli Herzig, François Verdon, Christiane Ruffieux, Stefan Bösner, Bernard Burnand, Thomas Bischoff, Norbert Donner-Banzhoff, Bernard Favrat

Published in: BMC Medicine | Issue 1/2010

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Abstract

Background

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.

Methods

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.

Results

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%.

Conclusions

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.
Appendix
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Metadata
Title
Ruling out coronary heart disease in primary care patients with chest pain: a clinical prediction score
Authors
Baris Gencer
Paul Vaucher
Lilli Herzig
François Verdon
Christiane Ruffieux
Stefan Bösner
Bernard Burnand
Thomas Bischoff
Norbert Donner-Banzhoff
Bernard Favrat
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2010
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-8-9

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