ToolsCalculators
INTERCHEST Clinical Prediction Rule for Chest Pain in Primary Care
Estimates likelihood of unstable coronary artery disease in primary-care patients with chest pain.
INTERCHEST Clinical Prediction Rule for Chest Pain in Primary Care
Age >=55 years (men) or >=65 years (women)
Physician's initial impression: patient may have a serious condition
Known history of coronary, cerebrovascular, or peripheral artery disease
Pain is brought on by exertion
Pain feels like "pressure"
Pain is reproducible by palpation
Result0 points
Score <2: unstable coronary artery disease is unlikely; outpatient work-up is reasonable.
- Prediction rule score
- 0
When to use
- Adults presenting to primary care with chest pain, to help decide between reassurance/outpatient work-up and urgent referral.
Formula
Sum of 6 equally weighted predictors (range -1 to 5): age/sex threshold (+1), physician suspects a serious diagnosis (+1), history of vascular disease (+1), pain brought on by exertion (+1), pain feels like pressure (+1), pain reproducible by palpation (-1). Score <2 argues against unstable CAD.
Pearls and pitfalls
- Derived from pooled individual patient data (3,099 patients) across five countries' primary-care chest pain cohorts.
- Not intended for use in the emergency department or in patients with an established acute coronary syndrome.