Cardiac Risk Stratification Scoring Systems for Suspected Acute Coronary Syndromes in the Emergency Department

Considerable time and resources are consumed investigating the many patients who present to emergency departments but who do not have an acute coronary syndrome. Consequently, researchers are increasingly modifying or developing cardiovascular risk-scoring systems for rule-out of acute coronary syndrome in patients who present to emergency departments with chest pain. Scoring systems range from those developed from statistical weighting of variables collected in observational studies to those developed from clinical judgment, logic, and common sense. The trend is towards systems using clinical logic and simple criteria. Although sensitivity and negative predictive value are the key parameters of interest when deciding to use a risk-assessment score to assist with chestpain rule-out decision-making, it is important to consider the proportion of patients that will be classified as low risk. If the numbers are significantly low, then adopting a riskscoring system in an early rule-out strategy is unlikely to impact upon patient flow and emergency-department overcrowding.