Signs and Evidence

Making clinical sense of scientific data


Beware of the limitations of this tool

Acute coronary syndrome

Calculated pretest probability: 3.74 %
Relevant inclusion criteria: Primary care, all chest pain 


1Exertional Pain
6Pain in left arm
7Epigastric pain

Clinical signs

9Chest-wall tenderness

To further investigations

Sources used:

1.Rudi Bruyninckx et al. Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract 2008; 58 (547): e1-e8.
2.Goodacre S et al. How Useful Are Clinical Features in the Diagnosis of Acute, Undifferentiated Chest Pain? Academic emergency medicine 2002; 9:203–208
3.Mant J et al. Systematic review and modelling of the investigation of acute and chronic chest pain presenting in primary care. Health Technology Assessment Volume: 8, Issue: 2, Published in February 2004
4.Zimmerman J et al. Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation. 1999 Apr 6;99(13):1671-7
5.Fanaroff AC et al. Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review. JAMA. 2015 Nov 10;314(18):1955-65
6.Cervellin G et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Ann Transl Med. 2016 Oct; 4(19): 362