Predictive value of modified early warning score and risk stratification for adverse cardiovascular events in acute chest pain patients.

OBJECTIVE: To assess the prognostic value of the modified early warning score (MEWS) in predicting major adverse cardiovascular events (MACE) within one month of admission, compared to established cardiac risk scores. METHODS: This retrospective study included 565 adults with acute chest pain who visited the Emergency Department between January 2023 and January 2024. Baseline demographics, medical history, vital signs, and clinical scores were collected. Patients were classified based on the occurrence of MACE - defined as cardiac death, ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), or coronary revascularization - within one month. RESULTS: Of the 565 patients, 112 (19.8%) experienced MACE. Patients in the MACE group had significantly higher clinical scores (all P<0.05). The MEWS score exhibited the strongest association with MACE (rho = 0.451, P<0.001) and remained a significant predictor in multivariate logistic regression (odds ratio = 4.416; 95% CI, 3.006-6.488; P<0.001). MEWS demonstrated the highest discriminative ability (area under the curve [AUC] = 0.826) compared to other scores tested. Random forest analysis confirmed MEWS as the most important predictor of MACE. CONCLUSION: The MEWS score outperforms traditional cardiac risk assessment tools in early prediction of major adverse cardiovascular events in acute chest pain patients. Its use could enhance risk stratification and inform clinical decision-making in emergency settings.