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Vol. 74. Issue 1.
Pages 113 (January 2021)
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Vol. 74. Issue 1.
Pages 113 (January 2021)
Letter to the Editor
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Chest pain unit: do not forget the clinical indexes
Unidad de dolor torácico: no olvidar los índices clínicos
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Manuel Martínez-Sellésa,
Corresponding author
mmselles@secardiologia.es

Corresponding author:
, Juan Sanchisb, Héctor Buenoc
a Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
b Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain
c Servicio de Cardiología, Hospital Universitario 12 de Octubre, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Universidad Complutense, Madrid, Spain
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To the Editor,

We have read with considerable interest the article by Piñeiro-Portela et al.,1 which compares 2 diagnostic imaging tests in the chest pain unit: stress echocardiography and multidetector computed tomography. Given that the included patients had a low-to-intermediate probability of having acute coronary syndrome (ACS), a normal or nondiagnostic electrocardiogram, and normal troponin levels, we believe that some of the participants did not require diagnostic imaging tests. The authors did not provide results on any of the clinical indexes typically applied to patients with ACS (eg, GRACE, TIMI, and HEART) or used in chest pain units.2–4 It would have been useful to report the results of the CPU-65 risk index (use of aspirin, diabetes, typical pain, age ≥ 65 years) and the index described by Sanchis et al.5 (male sex1, effort-related pain1, recurrent pain2, and prior ischemic heart disease2). Specifically, it would be valuable to know how many patients had index scores ≤ 1 and their outcomes. In addition, the authors should have indicated if high-sensitivity troponin was used, as well as one of the troponin algorithms with proven high sensitivity and negative predictive value for ACS diagnosis. Some evidence indicates that ischemic diagnostic tests might be overused in patients with low or intermediate risk,6 which is why some very low clinical index scores (0 or even 1) might be sufficient to discharge patients with normal electrocardiogram and troponin results from the emergency department. The overuse of ischemic diagnostic tests in low-risk patients prolongs their stay in emergency departments (and even compels their admission), increases the economic cost, and may even result in invasive procedures with no clear impact on patient prognosis.

References
[1]
M. Piñeiro-Portela, J. Peteiro-Vázquez, A. Bouzas-Mosquera, et al.
Comparison of two strategies in a chest pain unit: stress echocardiography and multidetector computed tomography.
Rev Esp Cardiol., 74 (2021), pp. 59-64
[2]
M. Martinez-Selles, H. Bueno, A. Estevez, J. De Miguel, J. Munoz, F. Fernandez-Aviles.
Positive non-invasive tests in the chest pain unit: importance of the clinical profile for estimating the probability of coronary artery disease.
Acute Card Care., 10 (2008), pp. 205-208
[3]
M. Martínez-Sellés, H. Bueno, A. Sacristán, et al.
Chest pain in the emergency department: incidence, clinical characteristics and risk stratification.
Rev Esp Cardiol., 61 (2008), pp. 953-959
[4]
J. Sanchis, E. Valero, S. García Blas, et al.
Undetectable high-sensitivity troponin in combination with clinical assessment for risk stratification of patients with chest pain and normal troponin at hospital arrival.
Eur Heart J Acute Cardiovasc Care., (2020),
[5]
J. Sanchis, S. García-Blas, A. Carratalá, et al.
Clinical evaluation versus undetectable high-sensitivity troponin for assessment of patients with acute chest pain.
Am J Cardiol., 118 (2016), pp. 1631-1635
[6]
I. Roifman, L. Han, M. Koh, et al.
Clinical effectiveness of cardiac noninvasive diagnostic testing in patients discharged from the emergency department for chest pain.
J Am Heart Assoc., 8 (2019), pp. e013824
Copyright © 2020. Sociedad Española de Cardiología
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