Background Heart Score is a simple and reliable post–test score to predict chest pain patients at higher risk of major adverse cardiac events (MACE), but fails in 1.5 to 2.5% of cases. Aim of this study was to evaluate the effectiveness of the nomogram in improving Heart Score performance. Methods In this multicenter retrospective study we considered all the patients consecutively observed for chest pain from January to June 2021 in the Emergency Departments of three Northern Italian hospitals. Main outcome was the onset of MACE within a 3 months–follow–up. All data were carefully recorded and included in univariate analysis. The variables associated with outcome (significance level p Results Overall 9837 patients (5863 males, 3974 females, mean age 63 ys) were eligible for the study. In the follow–up period 1671 patients (16.9%) developed a MACE (MACE+). Significant variables (p Conclusions In patients observed for chest pain nomogram achieved a more accurate stratification of low–risk ones than Heart Score.