{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:07:36Z","timestamp":1789549656847,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Undifferentiated chest pain is one of the most common reasons for emergency medical service (EMS) activation, yet its aetiological spectrum remains poorly characterised in the prehospital setting. Furthermore, no clinical prediction model has been specifically developed to identify patients at risk of significant coronary lesions using only information available before hospital arrival. This study aimed to describe the aetiologies of undifferentiated prehospital chest pain and develop a proof-of-concept clinical prediction model. Methods: We conducted a retrospective, single-centre study including 409 consecutive patients managed by the Orl\u00e9ans Mobile Intensive Care Unit (MICU) for undifferentiated chest pain between January and June 2024. Predictors of clinically significant coronary artery disease identified during in-hospital coronary assessment and management were evaluated using multivariable logistic regression. Model performance was assessed by discrimination and calibration, and internally validated using 1000 bootstrap resamples. Results: Cardiological aetiologies accounted for 19% of cases, including 53 patients (13%) meeting the primary outcome of clinically significant coronary artery disease. Four independent predictors were identified: age (OR 6.7\u20138.9 according to category), male sex (OR 2.2), typical chest pain (OR 6.6), and a positive family history of cardiovascular disease (OR 3.4). These variables were combined to develop the HATS (History, Age, Typical chest pain, Sex) model. The model demonstrated good discrimination (AUC 0.81), and satisfactory internal calibration (Hosmer\u2013Lemeshow p = 0.88), with limited optimism after bootstrap validation. Conclusions: This study characterises the aetiological spectrum of undifferentiated prehospital chest pain and proposes HATS as an exploratory proof-of-concept prediction model. Prospective multicentre external validation and subsequent assessment of clinical utility are required before any consideration of clinical implementation.<\/jats:p>","DOI":"10.3390\/jcm15187180","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:58:59Z","timestamp":1789545539000},"page":"7180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Undifferentiated Prehospital Chest Pain: Aetiologies and a Proof-of-Concept Model for Significant Coronary Lesions"],"prefix":"10.3390","volume":"15","author":[{"given":"Sophie","family":"Laporal","sequence":"first","affiliation":[{"name":"Emergency Department, Orl\u00e9ans University, Orl\u00e9ans University Hospital, 45100 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Giovannetti","sequence":"additional","affiliation":[{"name":"Emergency Department, Orl\u00e9ans University, Orl\u00e9ans University Hospital, 45100 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2043-3391","authenticated-orcid":false,"given":"Prabakar","family":"Vaittinada Ayar","sequence":"additional","affiliation":[{"name":"Emergency Department, Orl\u00e9ans University, Orl\u00e9ans University Hospital, 45100 Orl\u00e9ans, France"},{"name":"Laboratoire Interdisciplinaire pour l\u2019Innovation et la Recherche en Sant\u00e9 d\u2019Orl\u00e9ans, Medical School, Orl\u00e9ans University, Orl\u00e9ans University Hospital, 45100 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","unstructured":"Morice, L. (2022). \u00c9valuation par D\u00e9partement de L\u2019activit\u00e9 SMUR dans la R\u00e9gion Pays de la Loire sur la P\u00e9riode D\u2019octobre 2020 \u00e0 Octobre 2021. [Medical Thesis, Universit\u00e9 de Nantes]."},{"key":"ref_2","unstructured":"Schaffhauser, \u00c9. (2020). \u00c9tude des Dossiers Cod\u00e9s \u00abDouleur Thoracique\u00bb au Sein du Th\u00e9saurus du SMUR de Strasbourg. [Medical Thesis, Universit\u00e9 de Strasbourg]."},{"key":"ref_3","unstructured":"Malacrida, A., Azema, O., and Mourou, O. (2016). Panorama 2015 des Structures D\u2019urgence de Midi-Pyr\u00e9n\u00e9es, Observatoire R\u00e9gional des Urgences Midi-Pyr\u00e9n\u00e9es (ORU-MiP)."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1016\/j.jacc.2021.07.053","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"78","author":"Gulati","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.acvd.2024.08.005","article-title":"Epidemiology of Cardiovascular Risk Factors: Non-Behavioural Risk Factors","volume":"117","author":"Gabet","year":"2024","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by Representatives of 10 Societies and by Invited Experts) Developed with the Special Contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"37","author":"Piepoli","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1067\/mhj.2002.125625","article-title":"Symptom Presentation of Acute Myocardial Infarction: Influence of Sex, Age, and Risk Factors","volume":"144","year":"2002","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2623","DOI":"10.1001\/jama.294.20.2623","article-title":"Value and Limitations of Chest Pain History in the Evaluation of Patients with Suspected Acute Coronary Syndromes","volume":"294","author":"Swap","year":"2005","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1001\/jama.284.7.835","article-title":"The TIMI Risk Score for Unstable Angina\/Non\u2013ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making","volume":"284","author":"Antman","year":"2000","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1016\/j.ijcard.2013.01.255","article-title":"A Prospective Validation of the HEART Score for Chest Pain Patients at the Emergency Department","volume":"168","author":"Backus","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1136\/bmj.38985.646481.55","article-title":"Prediction of Risk of Death and Myocardial Infarction in the Six Months after Presentation with Acute Coronary Syndrome: Prospective Multinational Observational Study (GRACE)","volume":"333","author":"Fox","year":"2006","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1136\/emermed-2020-210212","article-title":"Prehospital Risk Stratification in Patients with Chest Pain","volume":"38","author":"Sagel","year":"2021","journal-title":"Emerg. Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.acvd.2024.10.328","article-title":"Epidemiology of Cardiovascular Risk Factors: Behavioural Risk Factors","volume":"117","author":"Grave","year":"2024","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_14","first-page":"741","article-title":"Family History of Coronary Artery Disease Is Associated with Acute Coronary Syndrome in 28,188 Chest Pain Patients","volume":"9","author":"Wahrenberg","year":"2020","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1136\/hrt.2003.027599","article-title":"The Health Care Burden of Acute Chest Pain","volume":"91","author":"Goodacre","year":"2005","journal-title":"Heart"},{"key":"ref_16","first-page":"76","article-title":"Diagnosis and Risk Stratification of Chest Pain Patients in the Emergency Department: Focus on Acute Coronary Syndromes. A Position Paper of the Acute Cardiovascular Care Association","volume":"9","author":"Stepinska","year":"2020","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_17","first-page":"243","article-title":"Evaluation of the Adult with Chest Pain in the Emergency Department","volume":"67","author":"Hollander","year":"2016","journal-title":"Angiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.annepidem.2022.04.010","article-title":"Incidence, Diagnoses and Outcomes of Ambulance Attendances for Chest Pain: A Population-Based Cohort Study","volume":"72","author":"Dawson","year":"2022","journal-title":"Ann. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wertli, M.M., Dangma, T.D., M\u00fcller, S.E., Gort, L.M., Klauser, B.S., Melzer, L., Held, U., Steurer, J., Hasler, S., and Burgstaller, J.M. (2019). Non-Cardiac Chest Pain Patients in the Emergency Department: Do Physicians Have a Plan How to Diagnose and Treat Them? A Retrospective Study. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211615"},{"key":"ref_20","first-page":"e344","article-title":"2014 AHA\/ACC Guideline for the Management of Patients with Non\u2013ST-Elevation Acute Coronary Syndromes","volume":"130","author":"Amsterdam","year":"2014","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1136\/heartjnl-2013-304599","article-title":"Effects of Prehospital 12-Lead ECG on Processes of Care and Mortality in Acute Coronary Syndrome: A Linked Cohort Study from the Myocardial Ischaemia National Audit Project","volume":"100","author":"Quinn","year":"2014","journal-title":"Heart"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Casarin, C., Pirot, A.-S., Gregoire, C., Van Der Haert, L., Vanden Berghe, P., Castanares-Zapatero, D., and Dechamps, M. (2022). Improving the Performance of a Triage Scale for Chest Pain Patients Admitted to Emergency Departments: Combining Cardiovascular Risk Factors and Electrocardiogram. BMC Emerg. Med., 22.","DOI":"10.1186\/s12873-022-00680-y"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1161\/CIRCULATIONAHA.110.968792","article-title":"Sex\/Gender Differences in Cardiovascular Disease Prevention: What a Difference a Decade Makes","volume":"124","author":"Mosca","year":"2011","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1001\/jama.291.18.2204","article-title":"Parental Cardiovascular Disease as a Risk Factor for Cardiovascular Disease in Middle-Aged Adults: A Prospective Study of Parents and Offspring","volume":"291","author":"Nam","year":"2004","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(04)17018-9","article-title":"Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-Control Study","volume":"364","author":"Yusuf","year":"2004","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the Management of Acute Coronary Syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:38:59Z","timestamp":1789547939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187180"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187180","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}