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Likelihood classification vs risk stratification in acute chest pain

Alex Manini, MD, MS

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Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029, USA

Nina Dannemann, BS

Cardiac MR PET CT Program, Harvard Medical School, Boston, MA 02115, USA

Javed Butler, MD

Cardiac MR PET CT Program, Harvard Medical School, Boston, MA 02115, USA

Fabian Bamberg, MD

Cardiac MR PET CT Program, Harvard Medical School, Boston, MA 02115, USA

John Nichols, BS

Cardiac MR PET CT Program, Harvard Medical School, Boston, MA 02115, USA

Udo Hoffmann, MD, MPH

Cardiac MR PET CT Program, Harvard Medical School, Boston, MA 02115, USA

David Brown, MD

Department of Emergency Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA

John Tobias Nagurney, MD, MPH

Department of Emergency Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA

DOI: http://dx.doi.org/10.1016/j.ajem.2009.01.021

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We thank Dr Eken for the thoughtful letter [1], which clearly highlights 2 important points. First, there are inherent difficulties with sorting out the concepts of likelihood classification vs risk stratification for a given disease process. Second, risk stratification is particularly problematic for patients with acute chest pain, especially that subset with normal initial cardiac biomarkers and a nondiagnostic electrocardiogram.

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© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.