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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Patent Pending

    INTERCHEST Clinical Prediction Rule for Chest Pain in Primary Care

    Rules out coronary artery disease (CAD) in primary care patients with chest pain.

    INSTRUCTIONS

    Do not use in an emergency setting.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients ≥30 years old presenting with chest pain in a primary care setting.

    • Should not be used in patients with a readily apparent cause of chest pain (e.g. trauma, infection), clear anginal equivalent symptoms (e.g. jaw pain, dyspnea on exertion, arm pain), or if other testing (e.g. electrocardiography, lab testing) has suggested a clearly cardiac etiology.

    • Not to be used for a positive diagnosis of angina or CAD, but as a negative tool to help assess who is low-enough risk to not need further evaluation.

    • While scores ≤1 make unstable CAD highly unlikely (NPV 98%), scores ≥2 are only modestly predictive of CAD (PPV 43%).

    • Most applicable to patients 30 years or older.

    • Only ~1.5% of patients seen in primary care for chest pain have unstable CAD (Cayley 2005, Klinkman 1994); the most common causes of chest pain in primary care are chest wall pain, gastrointestinal disease, and stable heart disease. 

    • Helps determine which outpatients with chest pain are at sufficiently low risk of unstable CAD to allow for further follow-up; testing and management to be done on a non-urgent outpatient basis (scores ≤1) or on an urgent or inpatient basis (scores ≥2).

    • Better at predicting presence of CAD (higher PPV) than the Marburg Heart Score, but has been less well studied (see Evidence for details).

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    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Marc Aerts

    About the Creator

    Marc Aerts, PhD, is a professor of biostatistics and director of the Center for Statistics at Hasselt University in Belgium. Dr. Aerts’ primary research is focused on mathematical and statistical models for disease prediction.

    To view Dr. Marc Aerts's publications, visit PubMed

    Are you Dr. Marc Aerts? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • William Cayley Jr, MD, MDiv
    About the Creator
    Dr. Marc Aerts
    Are you Dr. Marc Aerts?
    Content Contributors
    • William Cayley Jr, MD, MDiv