Analysis of patients presenting with chest pain in the emergency department using laboratory parameters and scoring in the prediction of acute coronary syndrome hospitalization

This study aimed to identify predictive factors that assist in the accurate triage of patients presenting with chest pain, supporting effective hospitalization decisions, clinical judgment, and optimized use of emergency department (ED) resources. A retrospective analysis was performed on 200 adult patients presenting with chest pain to the ED at Gaziantep City Hospital between December 2023 and January 2025. Patients were grouped into discharged (n=120) and hospitalized (n=80) categories. Demographic data, symptoms, laboratory results, electrocardiogram (ECG) findings, and clinical risk scores (History, ECG, Age, Risk Factors, Troponin (HEART) and Thrombolysis in Myocardial Infarction (TIMI)) were collected and analyzed. Independent predictors of hospitalization were identified using multivariable logistic regression. Hospitalized patients were generally older (median age 72 vs. 58, p<0.001) and more likely to have hypertension (75% vs. 41.7%, p<0.001), diabetes (50% vs. 25%, p<0.001), and hyperlipidemia (62.5% vs. 33.3%, p<0.001). Dyspnea and diaphoresis were significantly more prevalent among hospitalized individuals. Median troponin levels were also higher (0.025 ng/L vs. 0.010 ng/L, p<0.001). The HEART score demonstrated higher predictive value (AUC 0.79, 95% CI 0.72–0.86) than the TIMI score (AUC 0.68, 95% CI 0.61–0.75, p=0.012). Among those admitted, 56.3% had a confirmed diagnosis of acute coronary syndrome, compared to 12.5% of those discharged. Advanced age, cardiovascular comorbidities, dyspnea, diaphoresis, ischemic ECG findings, and elevated troponin independently predicted hospitalization. The HEART score proved to be more effective than TIMI in stratifying risk, supporting its clinical utility in improving ED triage and patient care.