SVEAT score: Acute chest pain risk stratification

SHAP analysis and comparative performance of the HEART, HET, and SVEAT scores in 30-day MACE prediction

BACKGROUND

This study aimed to compare the predictive performance of the HEART, HET, and SVEAT scores for 30-day major adverse cardiovascular events (MACE) in patients presenting with acute chest pain in the emergency department (ED).

METHODS

The HEART, HET, and SVEAT scores were retrospectively calculated, and their predictive performance for 30-day MACE was assessed using receiver operating characteristic (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analysis. Additionally, SHapley Additive exPlanations (SHAP) analysis was performed to quantify the contribution of each score to MACE prediction.

RESULTS

A total of 1330 patients were included, of whom 167 (12.6 %) experienced 30-day MACE. The HEART score exhibited the highest discriminatory performance (AUROC: 0.872, 95 % CI: 0.853-0.890), followed by the HET score (AUROC: 0.859, 95 % CI: 0.840-0.878). The SVEAT score had significantly lower predictive accuracy (AUROC: 0.823, 95 % CI: 0.802-0.844). Pairwise comparisons showed no statistically significant difference between the HEART and HET scores (p = 0.0787), whereas both HEART (p < 0.001) and HET (p < 0.001) significantly outperformed the SVEAT score. SHAP analysis confirmed that the HEART score contributed the most to MACE prediction.

CONCLUSION

Among the three risk stratification scores assessed, the HEART score demonstrated the highest predictive accuracy for 30-day MACE, followed by the HET score, while the SVEAT score showed lower performance. These findings support the HEART score as a preferred tool for risk stratification in acute chest pain evaluation in the ED.