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The Association of Electrocardiographic Abnormalities and Acute Coronary Syndrome in Emergency Patients With Chest Pain
Author(s) -
Knowlman Thomas,
Greenslade Jaimi H.,
Parsonage William,
Hawkins Tracey,
Ruane Lorcan,
Martin Paul,
Prasad Sandhir,
Lancini Daniel,
Cullen Louise
Publication year - 2017
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13123
Subject(s) - medicine , mace , acute coronary syndrome , chest pain , myocardial infarction , unstable angina , emergency department , cardiology , angina , percutaneous coronary intervention , psychiatry
Objectives The electrocardiograph ( ECG ) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome ( ACS ). A six‐point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department ( ED ) with suspected ACS . We set out to evaluate the efficacy of these criteria in identifying patients with major adverse cardiac events ( MACE ), Type 1 myocardial infarction (T1 MI ), Type 2 myocardial infarction (T2 MI ), and 1‐year mortality in a cohort of emergency patients with chest pain. Methods This was an analysis of data from 2,349 patients who presented to the ED with chest pain between 2008 and 2013. Data were collected as part of two prospective trials. ECG s were recorded at presentation and categorized according to the six‐point criteria by local cardiologists blinded to all clinical information. The primary outcome was 30‐day MACE , including T1 MI , T2 MI , unstable angina pectoris, revascularization, and 30‐day mortality. The outcome was adjudicated by cardiologists on the basis of all clinical information and test results. Likelihood ratios and odds ratios for 30‐day MACE were reported for each ECG category. Results Major adverse cardiac events were diagnosed in 264 (11.3%) patients. Increasing ischemic abnormalities in ECG s, as categorized by the standardized reporting criteria, were associated with increasing rates of MACE . Within 30 days, T1 MI occurred in 148 (6.3%) patients and T2 MI occurred in 59 (2.5%) patients. Risk for T1 MI increased with higher classification of ECG abnormalities. T2 MI rates were highest in patients with ECG s of nonspecific changes. Conclusions The rates of MACE , T1 MI , and 1‐year death can be stratified according to standardized ECG criteria in patients presenting to the ED with chest pain. The ECG findings in patients with T2 MI are variable, and the ECG is less helpful in defining risk in this group.