2025/10/31 by Keita Iyama, Shuntaro Sato, Ryohei Akashi +5 · 1 voice
Medicine · #Acute Myocardial Infarction Research #Cardiac Arrest and Resuscitation #Trauma and Emergency Care Studies
paper · pdf · doi:10.1186/s12245-025-01019-7
openalex created_date 2025/10/31 · openalex publication_date 2025/10/31 · openalex updated_date 2026/07/29
BACKGROUND: Early identification of acute coronary syndrome (ACS) in prehospital settings is crucial for optimal patient outcomes. However, existing risk assessment tools require laboratory data, making them unsuitable for prehospital use. Therefore, emergency medical technicians (EMTs) lack appropriate tools for prehospital ACS assessment and must rely on individual diagnostic skills, despite the importance of reducing prehospital time. To address this issue, a novel scoring system-Nagasaki Prehospital Chest Pain Assessment & Risk Determination (N-CARD)-was developed using only prehospital information and validated for use by EMTs, with the aim of improving patient outcomes and optimizing healthcare resource utilization. METHODS: In total, 584 participants with chest pain or suspected cardiac etiology who underwent a prehospital 12-lead electrocardiogram (ECG) between April 2023 and March 2024 were analyzed. The prehospital diagnostic score for ACS, N-CARD score, was developed using logistic regression based on the following variables: age, pain location, pain type, pain duration, coronary risk factors, and 12-lead ECG findings. Modeling was performed separately for high-risk and low-risk groups based on prior coronary artery disease (CAD) history. The model's performance was internally validated using bootstrap methods. RESULTS: The N-CARD scoring system was developed separately for participants without (N = 433) and with (N = 151) a history of CAD. The score ranged from - 1 to 10 for those without a history of CAD and 0 to 32 for those with a history of CAD. For participants without a history of CAD, scores ≥ 6 suggested ACS (specificity > 90%), whereas scores ≤ 3 suggested non-ACS (sensitivity > 90%), with an optimism-corrected area under the curve (AUC) of 0.90. For participants with a history of CAD, scores ≥ 24 suggested ACS, whereas scores ≤ 6 suggested non-ACS, with an optimism-corrected AUC of 0.69. CONCLUSIONS: The N-CARD scoring system, based solely on prehospital information, provides EMTs with an effective tool for assessing ACS risk in prehospital settings, potentially optimizing transport decisions and improving patient outcomes.