TOPLINE:

The PROMISE minimal risk score (PMRS) above 0.46 flagged more than 10% of patients with recent-onset stable chest pain as having a minimal risk. These patients had low rates of obstructive coronary disease, no heart attacks or deaths, and received fewer invasive tests than those flagged as having a higher risk.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis to test whether the PMRS could safely identify patients with recent‑onset stable chest pain who might avoid further testing.
• They included 3982 adults (median age, 64 years; 49.5% women) referred to a chest pain clinic at a UK-based hospital between April 2023 and August 2024.
• Electronic patient records were used to retrieve data on all the elements of the PMRS such as sex, age, smoking status, hypertension, diabetes, dyslipidaemia, and whether symptoms were exertional. Patients with a PMRS above 0.46 were classified as having a minimal risk, and those with a PMRS ≤ 0.46 were classified as having a higher risk.
• Researchers assessed whether patients underwent CT coronary angiography, invasive coronary angiography, or stress imaging. CT coronary angiography scans were used to identify obstructive coronary disease.
• The occurrence of myocardial infarction and all‑cause death were tracked over a median follow-up duration of 303 days.

TAKEAWAY:

• A total of 435 (10.9%) patients had a PMRS above 0.46 and were classified as having a minimal risk.
• The frequency of requesting CT coronary angiography did not differ between minimal- and higher-risk groups. Only three scans (0.7%) from the minimal-risk group showed obstructive coronary disease.
• Stress echo or MRIs were requested in 155 (4.4%) patients with a higher risk and seven (1.6%) with a minimal risk.
• None of the patients in the minimal-risk group had a myocardial infarction or died, whereas those in the higher-risk group had 43 myocardial infarctions and 31 deaths (log-rank P = .002).

IN PRACTICE:

"Deferral of further investigations in patients with a PMRS > 0.46 may represent an effective and safe strategy with beneficial implications for both patients and healthcare resource utilisation," the researchers of the study wrote.

SOURCE:

This study was led by Conor Tuffs, Royal Bournemouth Hospital, Dorset, England. It was published online on March 06, 2026, in Open Heart.

LIMITATIONS:

The study was a single‑centre retrospective analysis at one UK hospital. Some PMRS data were missing and were coded as the higher-risk category, which may have underestimated the minimal‑risk group. Few adverse events were reported, and causes of death were not specified.

DISCLOSURES:

The authors did not declare receiving any specific grant for the research or having any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.