Abstract
Background
In emergency department (ED) chest pain patients, it is believed that the diagnostic
accuracy of the electrocardiogram (ECG) for acute coronary syndrome (ACS) is higher
during ongoing than abated chest pain.
Objectives
We compared patient characteristics and the diagnostic performance of the ECG in ED
patients presenting with ongoing, vs. abated, chest pain.
Methods
In total, 1132 unselected ED chest pain patients were analyzed. The patient characteristics
and diagnostic accuracy for index visit ACS of the emergency physicians’ interpretation
of the ECG was compared in patients with and without ongoing chest pain. Logistic
regression analysis was performed to control for possible confounders.
Results
Patients with abated chest pain (n = 508) were older, had more comorbidities, and
had double the risk of index visit ACS (15%) and major adverse cardiac events (MACE)
at 30 days (15.6%) compared with patients with ongoing pain (n = 631; ACS 7.3%, 30-day
MACE 7.4%). Sensitivity of the ECG for ACS was 24% in patients with ongoing pain and
35% in those without, specificity was 97% in both groups, negative predictive value
was 94% and 89%, respectively, and positive likelihood ratio 10.6 and 7.8, respectively.
When the diagnostic performance was controlled for confounders, there was no significant
difference between the groups.
Conclusion
Our results indicate that ED chest pain patients with ongoing pain at arrival are
younger, healthier, and have less ACS and 30-day MACE than patients with abated pain,
but that there is no difference in the diagnostic accuracy of the ECG for ACS between
the two groups.
Keywords
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References
- Evaluation of the patient with acute chest pain.N Engl J Med. 2000; 342: 1187-1195
- Emergency department visits for chest pain and abdominal pain: United States, 1999–2008.NCHS Data Brief. 2010; : 1-8
- Does this patient with chest pain have acute coronary syndrome?: The rational clinical examination systematic review.JAMA. 2015; 314: 1955-1965
- The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document.Ann Noninvasive Electrocardiol. 2014; 19: 412-425
- Chest pain in the emergency department: clinical characteristics and management.Albanian J Med Health Sci. 2014; 45: 14
- Homepage with links to the different triage criteria.(Available at:) (Accessed September 2019)
- Homepage with links to the manual with triage criteria.(Available at:) (Accessed September 2019)
- The early evaluation of patients with chest pain.Clin Cardiol. 1998; 21: 703-704
- Electrocardiographic classification of acute coronary syndromes: a review by a committee of the International Society for Holter and Non-Invasive Electrocardiology.J Electrocardiol. 2010; 43: 91-103
- ECG diagnosis and classification of acute coronary syndromes.Ann Noninvasive Electrocardiol. 2014; 19: 4-14
- Diagnostic accuracy of high-sensitivity cardiac troponin T at presentation combined with history and ECG for ruling out major adverse cardiac events.Ann Emerg Med. 2016; 68: 649-658.e3
- A 0-hour/1-hour protocol for safe, early discharge of chest pain patients.Acad Emerg Med. 2017; 24: 983-992
- Predicare. About RETTS.(Available at:) (Accessed September 2019)
- 2014 AHA/ACC Guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 130: e344-e426
- A 1-h combination algorithm allows fast rule-out and rule-in of major adverse cardiac events.J Am Coll Cardiol. 2016; 67: 1531-1540
- Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial.Circulation. 2004; 110: 1598-1604
- Factors affecting outcome of primary percutaneous coronary intervention for acute myocardial infarction.ARYA Atheroscler. 2013; 9: 241-246
- 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).Eur Heart J. 2016; 37: 267-315
- Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris.Am J Cardiol. 1993; 72: 999-1003
- Clinical presentation and prognosis of left main coronary artery disease in the 1980s.Eur Heart J. 1991; 12: 495-502
- Chest Pain or Discomfort.in: 3rd edn. Clinical Methods: The History, Physical, and Laboratory Examinations. Chapter 9. Butterworths, Boston1990: 72-75
- Diagnostic values of chest pain history, ECG, troponin and clinical gestalt in patients with chest pain and potential acute coronary syndrome assessed in the emergency department.Springerplus. 2015; 4: 219
- Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.JAMA. 2012; 307: 813-822
- Diagnostic accuracy of history and physical examination for predicting major adverse cardiac events within 30 days in patients with acute chest pain.J Emerg Med. 2020; 58: 1-10
- The objective CORE score allows early rule out in acute chest pain patients.Scand Cardiovasc J. 2018; 52: 308-314
- Cost and outcomes of assessing patients with chest pain in an Australian emergency department.Med J Australia. 2015; 202: 427-432
- Patients with suspected acute coronary syndrome in a university hospital emergency department: an observational study.BMC Emerg Med. 2002; 2: 1
Article info
Publication history
Published online: April 11, 2020
Accepted:
March 18,
2020
Received in revised form:
February 12,
2020
Received:
October 24,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
