Nontraumatic chest pain and suspicion of acute coronary syndrome: associated clinical and electrocardiographic findings on initial evaluation
Miró O, Martínez-Nadal G, Jiménez S, Gómez-Angelats E, Alonso JR, Antolín A, Salgado E, Perelló R, Gualandro, DM, Strebel I, López-Ayala P, Rosselló X, Sans-Roselló J, Bragulat E, Sánchez M, Müller C, López-Barbeito B
Affiliation of the authors
Área de Urgencias, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. The GREAT (Global Reaseach on Acute Conditions Team) network, Roma, Italy. Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, Basilea, Switzerland. Centro Nacional de Investigación Cardiovascular, Madrid, Spain.
Miró O, Martínez-Nadal G, Jiménez S, Gómez-Angelats E, Alonso JR, Antolín A, et al. Nontraumatic chest pain and suspicion of acute coronary syndrome: associated clinical and electrocardiographic findings on initial evaluation. Emergencias. 2020;32:9-18
Summary
Objectives.
To analyze clinical data and electrocardiographic (ECG) findings obtained during the initial evaluation of patients with nontraumatic chest pain (NTCP). To explore associations between these findings and the initial and final diagnoses of acute coronary syndrome (ACS). To assess which variables initially over- or underestimate risk ACS.
Methods.
Consecutive patients with NTCP attended in a chest pain unit during the 10-year period of 2008–2017 were included if the suspected and discharge diagnoses of interest (ACS or non-ACS) had been recorded. Thirtythree independent variables (demographic, 2; cardiovascular, 5; chest pain, 22; ECG, 4). We included all variables in models to calculate crude and adjusted odds ratios (ORs) between each independent variable and the initial and final diagnoses. The adjusted ORs were compared to determine whether the initial and final diagnoses of ACS differed significantly in relation to the variables.
Results.
A total of 34 552 patient visits were attended. The ORs for the 33 variables were significantly associated with initial and final NTCP classification as ACS or non-ACS, and in many cases the association was confirmed by the adjusted ORs. The adjusted ORs for 19 variables were significantly different in their relation to the initial and final diagnoses of ACS: 10 overpredicted the probability of the diagnosis and 9 underpredicted it.
Conclusions.
The variables traditionally used to warn of ACS in emergency patients with NTCP identify individuals likely to be initially and finally diagnosed with ACS. However, some of these variables overestimate or underestimate the risk of a final ACS diagnosis. Emergency medicine physicians should be aware of variables associated with underestimation of risk.
