Acute chest pain ranks among the leading reasons for admission to the emergency department [1]. In the majority of cases within this patient group, cardiac ischemia is not detected [[2], [3], [4]]. However, distinguishing this low-risk chest pain patient group, in which cardiac ischemia is not identified, is not as straightforward for clinicians as diagnosing ST-segment elevation myocardial infarction (STEMI). Several risk scores are used to determine the risk class of patients presenting with acute chest pain. Although the European Society of Cardiology/Acute Coronary Syndromes (ESC/ACS) guidelines recommend the Global Registry of Acute Coronary Events (GRACE) scoring system, the History, ECG, Age, Risk factors, and Troponin I (HEART) score is currently the most commonly used scoring system due to its practicality [5,6]. The HEART score has been found to have a higher discriminatory power for identifying low-risk patient populations compared to previous studies on GRACE and Thrombolysis In Myocardial Infarction (TIMI) scoring, but it also has its limitations [[6], [7], [8], [9]]. The lack of clear definitions in scoring for typical angina and non-specific or ischemic electrocardiogram (ECG) changes leads to variations in scoring among users and potential misclassification of patient risk [6,9].

For this reason, Roongsritong et al. have proposed a new scoring system that could effectively identify low-risk patients [10]. They prepared the Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) scoring system with the hypothesis that using cardiovascular diseases rather than traditional risk factors would be more effective in differentiating low-risk patients. Similarly, they suggested that utilizing ECG changes known to strongly support ischemia, such as symmetric T-wave inversion and ST depression without other apparent causes, would be more effective. In this study, we aimed to compare the predictive power of the newly introduced SVEAT score with the widely used HEART score in predicting Major Adverse Cardiac Events (MACE).