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Journals / Anatolian Journal of Emergency Medicine / 2026 / Cilt: 9 Sayı: 3

Ordinal Coronary Artery Calcification Score: Acute Chest Pain Risk Stratification in the Emergency Department

Ordinal Koroner Arter Kalsifikasyon Skoru: Acil Serviste Akut Göğüs Ağrısı Risk Sınıflandırması

Mümin Murat Yazıcı(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-1957-7283
Yusuf Çubukçu(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ)0009-0006-5502-989X
Esat Kaba(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ)0000-0001-7464-988X
Özcan Yavaşi(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ)0000-0001-8641-7031
Ali Çelik(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ)0000-0003-2363-1844
Fatma Beyazal Çeliker(RECEP TAYYİP ERDOĞAN ÜNİVERSİTESİ)0000-0002-5420-9825
Pages
122–129
Publication Date
2026-09-25
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: The simple Ordinal score, assessed by an EMS on thorax CT, has high sensitivity and moderate specificity for detecting MACE in patients with chest pain.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: Chest pain is one of the most common reasons for visiting the emergency department (ED).
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Key Findings & Data:This study aimed to determine the diagnostic performance of the simple Ordinal Score in predicting 30-day major adverse cardiac events (MACE) in adult patients presenting to the ED with chest pain.
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Conclusion & Impact:Conclusion: The simple Ordinal score, assessed by an EMS on thorax CT, has high sensitivity and moderate specificity for detecting MACE in patients with chest pain.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Göğüs ağrısı · koroner arter kalsifikasyonu · basit ordinal skor

Abstract

Aim: Chest pain is one of the most common reasons for visiting the emergency department (ED). This study aimed to determine the diagnostic performance of the simple Ordinal Score in predicting 30-day major adverse cardiac events (MACE) in adult patients presenting to the ED with chest pain. Material and Methods: This single-center, cross-sectional study was conducted at the ED of a tertiary teaching and research hospital. All patients who presented with chest pain who did not meet the exclusion criteria were included. The simple Ordinal score was independently assessed on thorax computed tomography (CT) scans. The effectiveness of the simple Ordinal score in predicting MACE was evaluated using a receiver operating characteristic (ROC) curve analysis and diagnostic test characteristics. Results: Forty-nine patients were included in the study. MACE occurred in 10 patients but not in the remaining 39 patients. The area under the curve (AUC) for the simple Ordinal score assessed by the emergency medicine specialist (EMS) was 0.913, and the cut-off value was (≥ 4), with a sensitivity of 90.0% (95% CI, 55.5% - 99.8%) and a specificity of 74.4% (95% CI, 57.9% - 87.0%). The AUC for the simple Ordinal score by the radiologist was 0.921, and the cut-off value was (≥ 4), with a sensitivity of 90.0% (95% CI, 55.5% - 99.8%) and a specificity of 84.6% (95% CI, 69.5% - 94.1%). Conclusion: The simple Ordinal score, assessed by an EMS on thorax CT, has high sensitivity and moderate specificity for detecting MACE in patients with chest pain.

Özet

Amaç: Göğüs ağrısı, acil servise başvuru nedenleri arasında en sık görülenlerden biridir. Bu çalışmanın amacı, acil servise göğüs ağrısı şikayeti ile başvuran yetişkin hastalarda 30 günlük majör kardiyak olayları (MACE) öngörmede basit Ordinal Skorun tanısal performansını belirlemektir. Gereç ve Yöntemler: Bu tek merkezli, retrospektif çalışma, bir üçüncü basamak eğitim ve araştırma hastanesinin acil servisinde gerçekleştirilmiştir. Göğüs ağrısı ve/veya ilgili semptomlarla başvuran ve dışlama kriterlerini karşılamayan tüm hastalar çalışmaya dahil edildi. Basit Ordinal skor, torasik bilgisayarlı tomografi (BT) taramaları üzerinde bağımsız olarak değerlendirildi. MACE'yi öngörmede basit Ordinal skorun etkinliği, alıcı işletim karakteristiği (ROC) eğri analizi ve tanısal test karakteristikleri kullanılarak değerlendirildi. Bulgular: Çalışmaya 49 hasta dahil edildi. Bu hastaların 10'unda MACE gelişti, ancak 39'unda gelişmedi. Acil tıp uzmanı (ATU) tarafından değerlendirilen basit ordinal skor için eğri altındaki alan (AUC) 0,913 idi, kesme değeri (≥ 4) idi, duyarlılığı %90,0 (95% CI, 55,5% - 99,8%) ve özgüllüğü %74,4 (95% CI, 57,9% - 87,0%) idi. Radyolog tarafından basit ordinal skor için AUC 0,921 idi ve kesme değeri (≥ 4) idi, duyarlılık %90,0 (95% CI, 55,5% - 99,8%) ve özgüllük %84,6 (95% CI, 69,5% - 94,1%) idi. Sonuç: ATU tarafından torasik BT'de değerlendirilen basit Ordinal skoru, göğüs ağrısı olan hastalarda MACE'yi tespit etmek için yüksek duyarlılığa ve orta düzeyde özgüllüğe sahiptir.

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Cite This Article

Yazıcı, M. M., Çubukçu, Y., Kaba, E., Yavaşi, Ö., Çelik, A., Çeliker, F. B. (2026). Ordinal Coronary Artery Calcification Score: Acute Chest Pain Risk Stratification in the Emergency Department. Anatolian Journal of Emergency Medicine, Cilt: 9 Sayı: 3, 122–129. https://doi.org/10.54996/anatolianjem.1902219

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References (30)

  1. Centers for Disease Control and Prevention: National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables.) Accessed January 20, 2025. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf
  2. Than M, Herbert M, Flaws D, et al. What is an acceptable risk of major adverse cardiac event in chest pain patients soon after discharge from the Emergency Department? A clinical survey. Emerg Med J. 2014;31:864-9.
  3. Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK. Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review. JAMA. 2015;314:1955-65.
  4. Sentagne JP, Ohana M, Severac F, et al. Diagnostic performance of coronary calcifications on CT to rule out acute coronary syndrome in the emergency department. BMC Emerg Med. 2024;24:116.
  5. Byrne RA, Rossello X, Coughlan JJ, et al. ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-3826. doi: 10.1093/eurheartj/ehad191.
  6. Kudu E, Kucukardali AE, Altun M, et al. The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye. BMC Emerg Med. 2025;25(1):129.
  7. Kucukardali AE, Boraci Z, Kudu E, Karacabey S, Sanri E, Denizbasi A. Swift and Safe high-sensitive troPonin Evaluation in the Emergency Department with a 30-min protocol: The SPEED-30 cohort study. Am J Emerg Med. 2025;89:30-5.
  8. Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77.
  9. Haberl R, Becker A, Leber A, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients. J Am Coll Cardiol. 2001;37:451-7.
  10. Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, et al. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. Ann Emerg Med. 2016;68:659-670.
  11. Blair KJ, Allison MA, Morgan C, et al. Comparison of ordinal versus Agatston coronary calcification scoring for cardiovascular disease mortality in community-living individuals. Int J Cardiovasc Imaging. 2014;30:813-8.
  12. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827-32.
  13. Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860-70.
  14. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336-45.
  15. O'Malley PG, Greenberg BA, Taylor AJ. Cost-effectiveness of using electron beam computed tomography to identify patients at risk for clinical coronary artery disease. Am Heart J. 2004;148:106-13.
  16. Azour L, Kadoch MA, Ward TJ, Eber CD, Jacobi AH. Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges. J Cardiovasc Comput Tomogr. 2017;11:8-15.
  17. Htwe Y, Cham MD, Henschke CI, et al. Coronary artery calcification on low-dose computed tomography: comparison of Agatston and Ordinal Scores. Clin Imaging. 2015;39:799-802.
  18. Yazici MM, Sekmen S, Çelik A, Yavaşi Ö, Hürsoy N. The accuracy of the Hounsfield unit in pulmonary embolism diagnostics. Clin Exp Emerg Med. 2024;11:295-303.
  19. Esterson YB, Berkowitz JL, Friedman B, Hines JJ, Shah PK, Grimaldi GM. Clues to vascular disorders at non-contrast CT of the chest, abdomen, and pelvis. Abdom Radiol (NY). 2017;42:2175-87.
  20. Grandhi GR, Mszar R, Cainzos-Achirica M, et al. Coronary Calcium to Rule Out Obstructive Coronary Artery Disease in Patients With Acute Chest Pain. JACC Cardiovasc Imaging. 2022;15:271-80.
  21. Bosco E, Hsueh L, McConeghy KW, Gravenstein S, Saade E. Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review. BMC Med Res Methodol. 2021;21(1):241.
  22. Shemesh J, Henschke CI, Shaham D, et al. Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology. 2010;257:541-8.
  23. Shemesh J, Henschke CI, Farooqi A, et al. Frequency of coronary artery calcification on low-dose computed tomography screening for lung cancer. Clin Imaging. 2006 May-Jun;30(3):181-5. doi: 10.1016/j.clinimag.2005.11.002.
  24. Ljung L, Lindahl B, Eggers KM, Frick M, Linder R, Löfmark HB, Martinsson A, Melki D, Sarkar N, Svensson P, Jernberg T. A Rule-Out Strategy Based on High-Sensitivity Troponin and HEART Score Reduces Hospital Admissions. Ann Emerg Med. 2019 May;73(5):491-499. doi: 10.1016/j.annemergmed.2018.
  25. Kumar R, Kumari S, Zehra K, et al. Prospective Validation Of Heart Score For Suspected Acute Coronary Syndrome Patients. J Ayub Med Coll Abbottabad. 2022;34:452-57.
  26. Long B, Oliver J, Streitz M, Koyfman A. An end-user's guide to the HEART score and pathway. Am J Emerg Med. 2017;35:1350-55.
  27. Malguria N, Zimmerman S, Fishman EK. Coronary Artery Calcium Scoring: Current Status and Review of Literature. J Comput Assist Tomogr. 2018;42:887-97.
  28. Fresno CU, Tijmes FS, Thavendiranathan P, et al. Visual Ordinal Scoring of Coronary Artery Calcium on Contrast-Enhanced and Noncontrast Chest CT: A Retrospective Study of Diagnostic Performance and Prognostic Utility. AJR Am J Roentgenol. 2022;219(4):569-578.
  29. Siagian SN, Christianto C, Angellia P, Holiyono HI. The Risk Factors of Acute Coronary Syndrome in Young Women: A Systematic Review and Meta-Analysis. Curr Cardiol Rev. 2023;19(3):e161122210969. doi: 10.2174/1573403X19666221116113208.
  30. Jamil S, Jamil G, Mesameh H, et al. Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries. Int J Med Sci. 2021;18:3526-32.