Angiographic Findings, Heart Score, Laboratory Parameters, and Mortality in Patients Presenting to the Emergency Department with Chest Pain

Objective: Ischemic heart disease is the leading cause of global mortality, with chest pain being its most common symptom. Given its high prevalence and associated mortality, a comprehensive evaluation of cardiac function, angiographic findings, HEART Score, laboratory parameters, and mortality risk is essential for improving patient outcomes. This study aimed to examine the relationship between cardiac function, angiography reports, HEART Score, laboratory parameters, and mortality in patients presenting to the emergency department with chest pain.
Material and Methods: This single-center, retrospective study included 644 patients presenting with chest pain to the Gaziantep City Hospital Emergency Depart-ment between January and June 2024. Gaziantep City Hospital is a tertiary-care referral center with an annual emergency department census exceeding approximately 1.2 million visits, including a high volume of cardiovascular emergency admissions. Data on age, gender, laboratory findings, echocardiography, electrocardiography (ECG) changes, HEART Score, angiography reports, and hospital discharge outcomes were analyzed.
Results: Among the 644 patients, 32.8% had myocardial wall motion abnormalities, which were significantly associated with early mortality (p=0.026). Two-vessel dis-ease was present in 23.1% of patients, and three-vessel disease was present in 16.1%. Left anterior descending artery (LAD) stenosis ≥80% was associated with mortality (p=0.04) and multivessel disease (p<0.001). Although 47.8% of patients had ischemia-compatible ECG findings, these findings and troponin levels were not significantly associated with mortality. The neutrophil/lymphocyte ratio (AUC=0.641, p=0.004) and C-reactive protein (CRP) level (AUC=0.617, p=0.01) were significant predictors of mortality.
Conclusion: Myocardial wall motion abnormalities and LAD stenosis ≥80% were independent risk factors for mortality. The neutrophil/lymphocyte ratio and CRP level were also useful for predicting mortality. These findings may improve risk stratification and clinical decision-making for patients presenting to the emergency depart-ment with chest pain.

Keywords: Acute coronary syndrome, chest pain, HEART score, percutaneous coronary angiography