Emergency Department Chest Pain Patients With or Without Ongoing Pain: Characteristics,Outcome, and Diagnostic Value of the Electrocardiogram |
| |
| Affiliation: | 1. Department of Emergency Medicine, Skåne University Hospital, Lund, Sweden;2. Department of Cardiology, Skåne University Hospital, Lund, Sweden;3. Department of Clinical Sciences at Lund, Lund University, Lund, Sweden;1. Neurology Unit, San Gerardo Hospital, Monza, Italy;2. School of Medicine and Surgery and Milan-Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Milan, Italy;3. Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland;4. Department of Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland;5. Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland;1. Department of Pediatric Emergency Medicine, Children''s Hospital Colorado, Aurora, Colorado;2. University of Colorado, School of Medicine, Aurora, Colorado;1. Division of Medical Toxicology, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;2. Division of Medical Toxicology, Department of Emergency Medicine, University Hospitals, Cleveland Medical Center, Cleveland, Ohio;1. Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea;2. Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea;3. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea;1. Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland;2. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland;3. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland |
| |
| Abstract: | BackgroundIn 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.ObjectivesWe compared patient characteristics and the diagnostic performance of the ECG in ED patients presenting with ongoing, vs. abated, chest pain.MethodsIn 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.ResultsPatients 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.ConclusionOur 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: | emergency department chest pain ongoing abated ECG acute coronary syndrome myocardial infarction group characteristics outcome diagnostic value |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
