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1 2 3 Chest pain characteristics Type and location Constricting discomfort located retrosternally or in neck, jaw, shoulder or arm (I point) Aggravated by Physical or emotional stress (1 point) Main symptom either: Relieved by Rest or nitrates within 5 min (1 point) Symptom score Shortness of breath and/or trouble catching breath aggravated by physical exertion (2 points) Dyspnoea characteristics Symptom score Symptom score (0–3 points) Estimate the Risk Factor-weighted Clinical Likelihood (RF-CL) of obstructive CAD Number of risk factors for CAD (0–5): Family history, smoking, dyslipidaemia, hypertension and diabetes Age 30–39 Very low Low Moderate Age 40–49 Age 50–59 Age 60–69 Age 70–80 Clinical likelihood: 0–1 point 2 points 3 points Number of risk factors 4 7 11 0 1 2 2 4 7 1 2 5 1 1 3 0–1 2–3 4–5 Women 15 19 24 1 2 5 8 12 17 4 7 12 2 4 8 0–1 2–3 4–5 Men 6 10 16 0 1 3 3 6 11 2 3 7 1 2 5 0–1 2–3 4–5 Women 22 27 34 2 4 8 12 17 25 6 11 17 3 6 12 0–1 2–3 4–5 Men 16 19 23 2 5 10 10 14 19 6 10 15 4 7 12 0–1 2–3 4–5 Women 44 44 45 9 14 22 32 35 39 21 27 33 14 20 27 0–1 2–3 4–5 Men Chest pain (0–3 points) Dyspnoea (2 points) or Figure 4 Estimation of the clinical likelihood of obstructive coronary artery disease. CAD, coronary artery disease; RF-CL, risk factor-weighted clinical likelihood. Data derived from Winther et al.139 The symptom score replaces the previous, potentially misleading terminology, that defined presence of three chest pain characteristics as ‘typical’ angina (here = 3 points), two of three characteristics as ‘atypical’ angina (here = 2 points), and no or one characteristic as ‘non-cardiac/non-anginal’ (here = 0–1 point). Family history of CAD is defined as 1 or more first-degree relatives with early signs of CAD (men <55 and women <65 years of age); smoking, as current or past smoker; dyslipidaemia, hypertension, and diabetes, as present at the time of diagnosis. Values in the lower panel are the clinical likelihood estimates expressed as %. ESC Guidelines 3439 Downloaded from academic.oup.com/eurheartj/article/45/36/3415/7743115 by guest on 07 October 2026