Am J Emerg Med. 2026 Jan 22;102:141-147. doi: 10.1016/j.ajem.2026.01.033. Online ahead of print.
ABSTRACT
BACKGROUND: Acute chest pain is a common reason for emergency department consultation. In patients with suspected acute coronary syndrome but with non-elevated troponin and non-ischemic electrocardiogram, identifying those who require further testing remains a clinical challenge. The aim of the study was to assess the value of the risk factor-weighted clinical likelihood (RF-CL) model-derived pre-test probability (PTP) of coronary artery disease (CAD) for detecting obstructive CAD or myocardial ischemia, and for predicting major adverse cardiovascular events (MACE).
METHODS: Retrospective, single-center study including 3097 patients without prior CAD evaluated in a dedicated chest pain unit in Spain (2011-2021).
RESULTS: The prevalence of obstructive CAD or ischemia ranged from 2.3% in patients with very low PTP to 78.3% in those with high PTP. Each 1% increase in PTP was independently associated with higher odds of obstructive CAD or ischemia (OR 1.11, 95% CI 1.09-1.12) and greater risk of MACE (HR 1.04, 95% CI 1.03-1.05). The model showed strong discrimination for diagnosis (AUC 0.83) and acceptable prognostic performance (C-index 0.71). No patient with PTP ≤5% and non-elevated high-sensitivity troponin experienced adverse events within 30 days.
CONCLUSIONS: The PTP of CAD estimated by the RF-CL model was associated with the presence of obstructive CAD, myocardial ischemia and MACE in patients with suspected ACS, non-elevated troponin and non-ischemic electrocardiogram. Additional diagnostic testing may be safely deferred in patients with very low PTP (≤5%).
PMID:41616393 | DOI:10.1016/j.ajem.2026.01.033