Diagnostic precision of selected chest pain characteristics
| Sensitivity | Specificity | PPV | NPV | Pos. LR | Neg. LR | Accuracy | AUC | |
| Location* | ||||||||
| Retrosternal | 61.1 (53.3–68.4) | 57.1 (54.4–59.8) | 15.9 (14.2–17.8) | 91.7 (90.1–93.1) | 1.42 (1.24–1.63) | 0.68 (0.56–0.83) | 57.6 (55.0–60.1) | 0.591 |
| Precordial | 7.6 (4.1–12.6) | 76.5 (74.1–78.8) | 4.1 (2.5–6.8) | 86.2 (85.6–86.8) | 0.32 (0.19–0.55) | 1.21 (1.15–1.27) | 68.5 (66.0–70.8) | 0.421 |
| Sum typical† location | 95.9 (91.8–98.4) | 5.4 (4.2–6.8) | 11.9 (11.5–12.2) | 90.9 (82.4–95.5) | 1.01 (0.98–1.05) | 0.75 (0.35–1.61) | 16.0 (14.2–18.0) | 0.507 |
| Sum atypical‡ location | 6.4 (3.2–11.2) | 92.1 (90.4–93.5) | 9.7 (5.5–16.3) | 88.1 (87.7–88.5) | 0.80 (0.44–1.47) | 1.02 (0.97–1.06) | 82.0 (80.0–84.0) | 0.492 |
| Character | ||||||||
| Sum typical§ character | 89.5 (83.0–94.1) | 14.8 (12.8–17.1) | 11.5 (10.9–12.2) | 91.9 (87.2–95.0) | 1.05 (0.99–1.12) | 0.71 (0.42–1.19) | 23.1 (20.7–25.6) | 0.522 |
| Sum atypical¶ character | 21.8 (15.2–29.8) | 74.8 (72.1–77.4) | 9.7 (7.1–13.1) | 88.5 (87.5–89.5) | 0.87 (0.62–1.21) | 1.05 (0.95–1.15) | 69.0 (66.3–71.6) | 0.483 |
| Typical pain** | 84.6 (77.4–90.2) | 21.8 (19.4–24.3) | 11.7 (10.9–12.6) | 92.0 (88.4–94.5) | 1.08 (1.00–1.17) | 0.71 (0.47–1.17) | 28.6 (26.1–31.2) | 0.532 |
| Atypical pain†† | 15.4 (9.8–22.6) | 78.2 (75.7–80.6) | 8.0 (5.5–11.6) | 88.3 (87.4–89.1) | 0.71 (0.47–1.07) | 1.08 (1.00–1.17) | 71.4 (68.8–73.9) | 0.468 |
| Radiation | ||||||||
| Multiple directions | 27.8 (21.2–35.2) | 80.9 (78.6–83.0) | 15.8 (12.5–19.7) | 89.7 (88.7–90.5) | 1.45 (1.11–1.90) | 0.89 (0.81–0.98) | 74.8 (72.5–77.0) | 0.543 |
| Both arms | 19.5 (13.8–26.3) | 97.5 (96.5–98.3) | 50.0 (38.8–61.2) | 90.4 (89.7–91.0) | 7.76 (4.92–12.23) | 0.83 (0.77–0.89) | 88.6 (86.9–90.2) | 0.585 |
| Left arm | 20.7 (14.9–27.6) | 80.1 (77.8–82.2) | 11.8 (8.9–15.5) | 88.7 (87.8–89.5) | 1.04 (0.76–1.42) | 0.99 (0.91–1.07) | 73.3 (71.0–75.6) | 0.504 |
| Right arm | 1.18 (0.1–4.2) | 98.6 (97.8–99.2) | 10.0 (2.53–32.2) | 88.6 (88.4–88.7) | 0.86 (0.20–3.68) | 1.00 (0.98–1.02) | 87.5 (85.7–89.1) | 0.499 |
| Any radiation | 48.1 (45.4–50.9) | 48.1 (45.4–50.9) | 13.8 (12.4–15.4) | 91.3 (89.5–92.9) | 1.24 (1.10–1.41) | 0.74 (0.60–0.91) | 50.0 (47.4–52.6) | 0.563 |
| Additional symptoms‡‡ | ||||||||
| Sum typical§§ | 66.3 (58.8–73.2) | 33.2 (30.7–35.8) | 11.5 (10.4–12.7) | 88.2 (85.7–90.3) | 0.99 (0.89–1.11) | 1.02 (0.81–1.27) | 37.1 (34.6–39.6) | 0.497 |
| Sum atypical¶¶ | 8.6 (4.9–13.7) | 74.8 (72.3–77.1) | 4.3 (2.7–6.8) | 86.2 (85.5–86.8) | 0.34 (0.21–0.56) | 1.22 (1.16–1.29) | 67.1 (64.6–69.4) | 0.417 |
| Last 24 hours | ||||||||
| Exc. chest pain >once | 5.1 (2.4–9.5) | 97.1 (96.0–97.9) | 18.8 (10.2–31.9) | 88.6 (88.3–89.0) | 1.76 (0.87–3.56) | 0.98 (0.94–1.01) | 86.4 (84.6–88.1) | 0.511 |
| Last week | ||||||||
| Exertional chest pain | 35.4 (28.4–43.0) | 84.5 (82.5–86.4) | 23.1 (19.2–27.6) | 90.9 (89.9–91.8) | 2.29 (1.81–2.90) | 0.76 (0.68–0.85) | 78.8 (76.7–80.9) | 0.6 |
*In patients having chest pain at presentation.
†Summation of traditionally considered typical pain location like retrosternal, precordial, other parts of thorax, shoulder, arms, jaw or neck.
‡Summation of traditionally considered atypical pain location like epigastrium, abdomen, back or other locations.
§Summation of traditionally considered typical pain character like tight, crushing, dull or heavy.
¶Summation of traditionally considered atypical pain character like burning, stinging or other.
**Typical pain is defined as the combination of traditionally considered typical location and typical character.
††Atypical pain is defined as either atypical location or atypical character, or both.
‡‡If not stated considered negative.
§§Summation of traditionally considered typical additional symptoms like shortness of breath, nausea, vomiting. diaphoresis, clamminess, palpitations or dizziness.
¶¶Summation of traditionally considered atypical additional symptoms like pain dependent of position, respiration or palpation.
Accuracy, Sensitivity x prevalence + specificity x (1 - prevalence); AUC, Area under receiver operating characteristics curve; LR, likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.