Table 1

Study characteristics

Derivation studyValidation studiesInclusion criteriaNo. of analysed patientsOutcomeReference standardMean age of patients, yearsType of validationPrevalence of illnessQUADAS score
Goldman et al26Main issue of anterior, precordial, or left lateral pain unexplained by obvious trauma or chest film abnormalities, age >30, ED482MIA–1210
Goldman et al26Main issue of anterior, precordial, or left lateral pain unexplained by obvious trauma or chest film abnormalities, age > 30, ED468MIA–21810
Poretsky et al31Hospitalised patients with chest pain.186MIA6524411
Grijseels et al17Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service906ACSA, B6724211
Goldman et al31ED, main issue of chest pain unexplained by obvious local trauma or chest film abnormalities, > 30 years1379MIA561911
Goldman et al31ED, main issue of chest pain unexplained by obvious local trauma or chest film abnormalities, > 30 years4770MI5621211
Grijseels et al17Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service906ACS6724711
Selker et al8Main issues of chest pain, shortness of breath, upper abdominal pain, or dizziness; male > 30, female > 40 years3453ACSA623611
Selker et al8Main issues of chest pain, shortness of breath, upper abdominal pain, or dizziness; male >30, female >40 years2320ACSA, B6213111
Seyal et al9Chest or upper abdominal pain admitted to ED or ICU, except patients with pacemaker, 20 to 80 years255MIA–2739
Miller et al10 (USA)Symptoms suggestive of ACS prompting an ECG, in ED9239ACSC57.427.610
Miller et al10 (Singapore)Symptoms suggestive of ACS prompting an ECG, in ED2752ACSC–215.610
Mitchell et al11Patients evaluated for ACS in the ED or chest pain unit1114ACSC50.72510
Kellett12Patients with suspected MI admitted to coronary care unit600MIA, (C for patients included after March 1996)642368
Pozen et al6Consecutive patients with suspected ischaemic heart disease; ED401ACSA, B551610
Grijseels et al17Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service906ACS6724211
Pozen et al24Main symptom of chest pain, jaw or left arm pain, shortness of breath, changed patterns of angina pectoris; male >30, female > 40 years1288ACSA, B623211
Grijseels et al17Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service906ACS6724211
Green and Smith33Patients admitted with admission ECG and serial CK-MB and LDH measurements108MIA692227
Tierny et al25Patients with chest pain, ED540MI561111
Grijseels et al17Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service906ACS6724711
Kennedy et al21Main issue of non-traumatic chest pain, ED600ACSA572610
Kennedy et al21Main issue of non-traumatic chest pain, ED662ACS6024510
Kennedy et al21Patients with chest pain; ED1223ACSB, C586111
Kennedy et al21, hospital 2Patients with chest pain; ED1268ACSB, C62.526811
Hospital 3Patients with chest pain; ED626ACSB, C60.477
Hospital 4Patients with chest pain; ED152ACSB, C63.792
Grijseels et al17Patients with chest pain; ED906ACS––10
Grijseels et al34Patients with symptoms of possible cardiac origin, seen by a general practitioner and subsequently transferred to the hospital by the ambulance service977ACS6614810
Dilger et al28Patients admitted to ED or ICU for suspected myocardial infarction87MID60759
Dilger et al28Patients admitted to ED or ICU for suspected myocardial infarction122MID591379

  • Type of validation: 1=temporal validation, 2=geographical validation, 3=domain validation, 4=within sample validation.40 Reference standards are as follows. A: clinical symptoms; repeated measurement of cardiac enzymes (CK, CK-MB, LDH, SGOT), ECG changes corresponding to WHO criteria. B: unstable angina was defined as a history of angina with increasing frequency and severity of symptoms. New or recent onset of angina was defined as angina with subsequent documentation of either ST-T changes at t rest, an abnormal stress test or an abnormal arteriogram. C: definition published by European Society of cardiology.41 D: elevation of CK and CK-MB within 22 h after admission, CK-MB had to be between 6% and 25% of total CK activity.42

  • ACS, acute coronary syndrome; CK, creatine kinase; ECG, electrocardiogram; ED, emergency department; ICU, intensive care unit; LDH, lactate dehydrogenase; MI, myocardial infarction; QUADAS, Quality Assessment of Diagnostic Accuracy Studies; SGOT, serum glutamic oxaloacetic transaminase.