Chest Pain Clinical Trial
Official title:
Validation of the SCARE Score, Predictive Score of Acute Coronary Syndrome During the Assessment of Chest Pain in the Call Center.
Chest pain is a very common reason for resorting to the call center. The etiologies are very
varied, ranging from benign pathologies to some that may involve, in the short term, the
vital prognosis such as Acute Coronary Syndrome (ACS). ACS is a partial or complete occlusion
of a coronary artery that causes potentially irreversible myocardial pain unless prompt
treatment is undertaken. ACS represents 120 000 cases per year in France and causes about 18
000 deaths. There is currently no support score for the assessment of chest pain. However,
reducing the duration of management of ACS is essential in order to hope to reduce the
associated morbidity and mortality. In 2016, SAMU45's team established a predictive ACS score
for the assessement of chest pain in SAMU 45 (France) based on the prospective study of 1367
patients. Seven items significantly associated with this risk of ACS could be highlighted:
age, sex, smoking, typicality (potentially constrictive chest pain radiating potentially to
the shoulders and / or jaw) pain, inaugural character of pain (ie first episode of this
type), presence of sweats and the physician's belief to be in the presence of an ACS. These
seven variables make up the SCARE score. This had good internal discrimination (AUC at 0.81)
and excellent calibration ("p" of Hosmer-Lemeshow at 0.74). This score makes it possible to
stratify the risk of ACS, by using epidemiological elements but also the physician's belief,
whose Negative Predictive Value (VPN) proved excellent.
The objective of this new project is to confirm by an external validation via a multicentric
study the robustness of this score and thus be able to consider its use in front of any chest
pain regulated in France by a call center.
The main objective is to validate the predictive SCARE score of acute coronary syndrome
during the medical assessment of chest pain. The primary endpoint will be SCARE score
analysis (pre-established in 2016) with assessment of its calibration (Hosmer Lemeshow) and
discrimination (AUC) in a multicenter population of chest pain with a potential diagnosis of
Acute Coronary Syndrome established according to the European Society of Cardiology criteria.
This is a multi-center study including any patient over 18 years of age calling call center
for chest pain over a period of six months. It will exclude post-traumatic chest pain,
patients under 18 years old, patients who do not speak French, patients refusing to
participate in the study or refusing treatment, patients not affiliated to social security,
patients incarcerated in a penitentiary center, patients under tutorship, curatorship or
safeguard of justice.
The collection of data will be carried out thanks to files filled prospectively by the
medical physician for each call for the reason of a chest pain. These cards will list the
epidemiological data (age, sex, weight, height) and clinical data of each patient, as well as
the decision and the resources committed by the regulating physician (hospital care via SMUR
or ambulance, treatment in city medicine). For hospitalized patients, the diagnosis of ACS
will be retained if the patient meets the criteria defined by the European Society of
Cardiology. For patients managed in ambulatory medicine, a telephone call to the patient will
be made at one month to obtain the diagnosis.
Then, the SCARE score will be analized in this multicenter population with evaluation of its
calibration (Hosmer Lemeshow) and discrimination (AUC). The characteristic performances of
the score (sensitivity, specificity, PPV, NPV, positive and negative likelihood ratios)will
also be analized.
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