Retrospective analysis of the specificity and sensitivity of EDACS, EDACS-ADP and heart clinical scoring systems for detection of thirty-day major adverse cardiac events in patients presenting to the emergency department for ischemic chest pain

EDACS, EDACS-ADP and HEART scoring systems are highsensitivity scoring systems developed for patients with chest pain presenting to the emergency department, which are simple to apply, and which enable safe discharge in the early period. The aim of our study is to determine the sensitivity and specificity of EDACS, EDACS-ADP and HEART scoring systems in calculating the 30-day risk of major adverse cardiac events in patients admitted to our emergency department with chest pain. The study was conducted by retrospectively scanning the files of patients aged 18 years and older who applied to Bursa Uludağ University Medical Faculty Emergency Medicine Clinic between January 1, 2020 and January 1, 2021. Patients' age, gender, smoking, family history (early cardiovascular disease or death in the family), past medical history (CAD, HT, DM, HL), ECG findings, characteristic of chest pain and accompanying findings, troponin, CK, CK-MB values and the way the patients ended up (admission, discharge, ex) were recorded. Within the scope of our study, score calculations were made in terms of EDACS, EDACS-ADP and HEART clinical scores of the patients. Major adverse cardiac events that occurred within thirty days following the admission to the emergency department were recorded from the patient files and via E-Nabız. The study was completed with 310 patients meeting all criteria. 70.65% (n=219) of all patients were male and 29.35% (n=91) were female. The mean age of the patients included in the study was 56.71±13.72 years. Of the 310 patients included in the study, 196 (63.22%) were diagnosed with nonspecific chest pain and were discharged. At the time of admission, 67 patients were diagnosed with NSTEMI (21.61%) and 47 patients with USAP (15.16%). Of the patients diagnosed with NSTEMI at the time of admission, 38 (56.71%) high-risk patients according to EDACS, 29 (43.28%) low-risk patients, 65 (97.01%) high-risk patients according to EDACS-ADP, low-risk patients 2 (2.98%) at risk, 36 (53.73%) with high risk according to HEART, 29 (43.28%) with medium risk, and 2 (2.98%) with low risk. A total of 141 MACEs developed in 90 (29.03%) of the patients included in the study. MACE developed after discharge in 9 of the patients participating in the study. Based on the data of our study, EDACS, EDACS-ADP and HEART were evaluated to predict the presence of MACE in those with high risk and EDACS 57.78% sensitivity, 69.09% specificity for high-risk, 92.22% sensitivity, 62.27% specificity for EDACS-ADP high-risk, and 43.33% sensitivity, 97.73% specificity for HEART high-risk has been obtained. According to the EDACS-ADP and HEART scores applied to the patients who came to the emergency department with chest pain, the discharge rate of the patients who were considered low risk was more than 90%. In addition, it is a valuable tool of emergency services with its reliable sensitivity and high NPD in finding patients who are not low risk.