Chest Pain Score had lower AUC in females (0.64) vs males (0.74, p=0.02), while modified HEART score performed similarly in both genders (AUC ~0.83).
Does the performance of the Chest Pain Score and modified HEART score in predicting MACE differ between male and female patients presenting to the ED with chest pain?
The Chest Pain Score performs significantly worse in predicting MACE in women compared to men, whereas the modified HEART score maintains similar predictive accuracy across both genders.
Absolute Event Rate: 0% vs 0%
Abstract Background Early risk stratification of patients with chest pain (CP) is crucial. Gender differences in CP presentation may affect the accuracy of clinical scores. Women often present with atypical symptoms, potentially leading to misclassification and missed diagnoses. Purpose To assess the performance of the Chest Pain Score (CPS) (Table 1) and modified HEART score (mHS) in predicting major adverse cardiac events (MACE) in male and female patients. Methods This single-center, prospective observational study is a secondary analysis of a database containing prospectively collected data from patients presenting to the emergency department (ED) with CP as their primary symptom (1st Jan 2022 and 31st Dec 2022). The primary objective is to evaluate the performance of CPS and mHS in predicting Major Adverse Cardiac Events (MACE) in male and female patients. Performance will be assessed using the area under the curve (AUC) in receiver operating characteristic (ROC) analysis. AUC comparisons between genders performed using the DeLong test. Statistical analysis will be conducted using SPSS 29.0. Results We included 1,484 CP patients, 594 (40.0%) were female. The mean age was 60.2±15.6 years, with no significant gender difference (males: 59.2±15.5; females: 61.7±15.7; p=0.59). MACE occurred in 212 patients (14.3%), more frequently in males (18% vs. 8.6%, p0.001). Regarding cardiovascular risk factors, diabetes (23.9%), hypertension (27.1%), dyslipidemia (35.2%), smoking (15.8%), family history of cardiovascular disease (CVD) (7.6%), and obesity (8.1%). Diabetes (30.7% vs. 19.4%, p0.001) and family history of CVD (10.3% vs. 5.7%, p=0.02) were more frequent in females, while dyslipidemia was more common in males (38.0% vs. 31.0%, p=0.04). No significant gender differences were found for hypertension, obesity, or smoking. For the CPS, the mean value in the overall population was 5.9±1.9, with an AUC of 0.71 (95% CI: 0.67–0.75). The AUC in males was 0.74 (95% CI: 0.70–0.79), while in females it was 0.64 (95% CI: 0.56–0.71) (Figure 1), with a statistically significant difference (p=0.02). The mean mHS in the overall population was 3.5±2.1, with an AUC of 0.83 (95% CI: 0.80–0.85). The AUC in males was 0.83 (95% CI: 0.81–0.87), while in females it was 0.82 (95% CI: 0.76–0.87) (Figure 1), with no significant differences between the AUCs (p=0.52). Regarding the individual components of the mHS, a significant difference was observed between male and female patients in the classification of typical versus atypical CP in relation to cardiovascular events (p0.001). Conclusion CPS shows significantly lower performance in females. Furthermore, the slightly worse performance of the mHS in females, though not statistically significant, appears to be due to its rough classification of pain. Dedicated prospective studies are needed to develop prognostic scores that account for the differing characteristics of CP between genders.Figure 1.ROC curves Chest Pain Score
Pelagatti et al. (Sat,) reported a other. Chest Pain Score had lower AUC in females (0.64) vs males (0.74, p=0.02), while modified HEART score performed similarly in both genders (AUC ~0.83).