Correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales

Objective: To identify correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales. Design: Prospective cohort study. Setting: The emergency departments of three university and four community hospitals. Patients: Five hundred patients more than 30 years of age presenting to the emergency departments between 1984 and 1985 with a chief complaint of chest pain not explained by obvious trauma or chest x-ray abnormalities, and more than bibasilar rales on physical examination. Measurements and main results: A standard data form was used to collect the history, physical examination, vital sign, and electrocardiographic findings. Chart review was carried out to record complications and mortality. One hundred eleven (22%) of the patients had a major complication (ventricular fibrillation, Mobitz II heart block, complete heart block, atrioventricular dissociation, cardiogenic shock, cardiac arrest, endotracheal intubation, intra-aortic balloon pump) or died, 160 (32%) were diagnosed as having myocardial infarction, and 58 (12%) died. Of those patients who had major complications or who died, the first complication occurred within six hours of hospital admission for 32% of the patients and within 24 hours for 47% of the patients. Univariate correlates (p<0.10) of a major complication or death were entered into a stepwise logistic regression model. In the multivariate model, ST elevation or Q waves not known to be old [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI) 3.0–11.1], ST-T changes of ischemia not known to be old (OR 2.6, 95% CI 1.5–4.6), systolic blood pressure ≤ 120 mm Hg (OR 3.2, 95% CI 1.9–5.6), and age >70 years (OR 1.8, 95% CI 1.1–3.0) were correlates of a major complication or death. Conclusion: For patients presenting to the emergency department with chest pain and more than bibasilar rales, major electrocardiographic changes, systolic blood pressure ≤ 120 mm Hg, and age >70 years were correlated with a higher risk of a major complication or death. Supported by a grant (83102-2H) from the John A. Hartford Foundation, New York. Dr. Lee is the recipient of an Established Investigator Award (900119) from the American Heart Association.