Wamala H, et al. – In this study, researchers compared the performance of nine risk scores for coronary heart disease among patients presenting to an emergency room with undifferentiated chest pain of possible coronary origin. Of the 401 patients evaluated, 123 had ischemic chest pain. Of the nine risk scores, the NACPR score, HEART score, and TIMI score demonstrated the greatest ability to identify low-risk patients. The HEART score exhibited the greatest ability to distinguish patients with noncardiac chest pain from patients with ischemic chest pain; the ADAPT score demonstrated the lowest ability. In excluding ischemic chest pain, ADAPT had negative predictive value (NPV) 100% (miss rate 0%) but classified only 1.7% of patients as low risk vs NACPR with NPV 98% (miss rate 2%), classifying 10.2% as low risk, and HEART with NPV 94% (miss rate 6%), classifying 32.4% as low risk. Overall, the NACPR risk score capitalized yield of low-risk patients with lowest miss rate for ischemic chest pain, while the HEART score classified the highest proportion of low-risk patients but with a higher miss rate.