Chest pain is one of the most common presenting complaints of a cardiac ischemic event. As the presenting complaint often dictates further interventions, it is necessary to identify and stratify the risk of a cardiac ischemic event in cases of chest pain as the primary complaint. The study also aimed to evaluate the actual number of cardiac ischemic events from all cases of complaints of chest pain. The study aimed to evaluate the occurrence of chest pain as an emergency attended by our emergency management service--108 services. During the period of January 1st-December 31st 2007, a total of 9,130 calls with chest pain were attended to, out of which 6,235 (68.3%) were included who were patients above 30 years of age and for whom complete data were available. Risk factor analysis to predict myocardial events and stratification was done to calculate an odds ratio. A cardiac risk scoring was devised and analyzed for probability of survival against final outcome. Probable cardiac cases were 5,887, out of which the critical/mortal cases were chosen for risk factor analysis and stratification. This resulted in age (odds ratio: 1.6; 95% CI: 1.3-2.0) and respiratory rate (odds ratio: 1.4; 95% CI: 1.1-1.8) being significant risk factors. The cardiac risk scoring accurately predicted 71% of final outcome. Age and respiratory rate may be constituted as primary qualifying criteria to define a cardiac ischemic event and given higher weights in risk scoring. Systolic blood pressure, which showed a non-significant change, may also be included to accurately identify cardiac ischemic events. From the total sample of patients presenting with chest pain, only 5.5-8% were definitive cardiac ischemic events.