ABSTRACT
BACKGROUND: Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis. AIM: To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit. MATERIAL AND METHODS: Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression. RESULTS: In a four years period, 1,168 patients aged 62+/-23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29). CONCLUSIONS: Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.
Subject(s)
Acute Coronary Syndrome/diagnosis , Chest Pain/diagnosis , Acute Coronary Syndrome/blood , Biomarkers/blood , Chest Pain/blood , Electrocardiography , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Odds Ratio , Patient Discharge , Predictive Value of Tests , Prospective Studies , Risk Assessment , Troponin I/bloodABSTRACT
Background: Nearly 10 percent of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis. Aim To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit. Material and methods: Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression. Results: In a four years period, 1,168 patients aged 62±23 years (69 percent males), were studied. After initial evaluation, 62 percent of the patients were admitted to the hospital for further testing and in 71 percent of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95 percent confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95 percent CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95 percent CI 1.25-2.69), age over 65years (OR 1.73, 95 percent CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95 percent CI 3.72-8.29). Conclusions: Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.
