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Diagnostic Accuracy of History and Physical Examination for Predicting Major Adverse Cardiac Events Within 30 Days in Patients With Acute Chest Pain

Eriksson, David LU ; Khoshnood, Ardavan LU ; Larsson, David LU ; Lundager-Forberg, Jakob LU ; Mokhtari, Arash LU and Ekelund, Ulf LU (2020) In Journal of Emergency Medicine 58(1). p.1-10
Abstract

BACKGROUND: The cornerstones in the assessment of emergency department (ED) patients with suspected acute coronary syndrome (ACS) are patient history and physical examination, electrocardiogram, and cardiac troponins. Although there are several prior studies on this subject, they have in some cases produced inconsistent results.

OBJECTIVE: The aim of this study was to evaluate the diagnostic and prognostic accuracy of elements of patient history and the physical examination in ED chest pain patients for predicting major adverse cardiac events (MACE) within 30 days.

METHODS: This was a prospective observational study that included 1167 ED patients with nontraumatic chest pain. We collected clinical data during the initial ED... (More)

BACKGROUND: The cornerstones in the assessment of emergency department (ED) patients with suspected acute coronary syndrome (ACS) are patient history and physical examination, electrocardiogram, and cardiac troponins. Although there are several prior studies on this subject, they have in some cases produced inconsistent results.

OBJECTIVE: The aim of this study was to evaluate the diagnostic and prognostic accuracy of elements of patient history and the physical examination in ED chest pain patients for predicting major adverse cardiac events (MACE) within 30 days.

METHODS: This was a prospective observational study that included 1167 ED patients with nontraumatic chest pain. We collected clinical data during the initial ED assessment of the patients. Our primaryoutcome was 30-day MACE.

RESULTS: Pain radiating to both arms increased the probability of 30-day MACE (positive likelihood ratio [LR+] 2.7), whereas episodic chest pain lasting seconds (LR+ 0.0) and >24 h (LR+ 0.1) markedly decreased the risk. In the physical examination, pulmonary rales (LR+ 3.0) increased the risk of 30-day MACE, while pain reproduced by palpation (LR+ 0.3) decreased the risk. Among cardiac risk factors, a history of diabetes (LR+ 3.0) and peripheral arterial disease (LR+ 2.7) were the most predictive factors.

CONCLUSIONS: No clinical findings reliably ruled in 30-day MACE, whereas episodic chest pain lasting seconds and pain lasting more than 24 h markedly decreased the risk of 30-day MACE. Consequently, these two findings can be adjuncts in ruling out 30-day MACE.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute Coronary Syndrome, ACS, Major Cardiac Event, MACE
in
Journal of Emergency Medicine
volume
58
issue
1
pages
10 pages
publisher
Elsevier USA
external identifiers
  • scopus:85081206628
  • pmid:31780182
ISSN
0736-4679
DOI
10.1016/j.jemermed.2019.09.044
language
English
LU publication?
yes
id
e172f309-69e5-4e89-9278-e02d4d5e144a
date added to LUP
2019-12-10 21:29:48
date last changed
2020-07-08 05:09:09
@article{e172f309-69e5-4e89-9278-e02d4d5e144a,
  abstract     = {<p>BACKGROUND: The cornerstones in the assessment of emergency department (ED) patients with suspected acute coronary syndrome (ACS) are patient history and physical examination, electrocardiogram, and cardiac troponins. Although there are several prior studies on this subject, they have in some cases produced inconsistent results.</p><p>OBJECTIVE: The aim of this study was to evaluate the diagnostic and prognostic accuracy of elements of patient history and the physical examination in ED chest pain patients for predicting major adverse cardiac events (MACE) within 30 days.</p><p>METHODS: This was a prospective observational study that included 1167 ED patients with nontraumatic chest pain. We collected clinical data during the initial ED assessment of the patients. Our primaryoutcome was 30-day MACE.</p><p>RESULTS: Pain radiating to both arms increased the probability of 30-day MACE (positive likelihood ratio [LR+] 2.7), whereas episodic chest pain lasting seconds (LR+ 0.0) and &gt;24 h (LR+ 0.1) markedly decreased the risk. In the physical examination, pulmonary rales (LR+ 3.0) increased the risk of 30-day MACE, while pain reproduced by palpation (LR+ 0.3) decreased the risk. Among cardiac risk factors, a history of diabetes (LR+ 3.0) and peripheral arterial disease (LR+ 2.7) were the most predictive factors.</p><p>CONCLUSIONS: No clinical findings reliably ruled in 30-day MACE, whereas episodic chest pain lasting seconds and pain lasting more than 24 h markedly decreased the risk of 30-day MACE. Consequently, these two findings can be adjuncts in ruling out 30-day MACE.</p>},
  author       = {Eriksson, David and Khoshnood, Ardavan and Larsson, David and Lundager-Forberg, Jakob and Mokhtari, Arash and Ekelund, Ulf},
  issn         = {0736-4679},
  language     = {eng},
  number       = {1},
  pages        = {1--10},
  publisher    = {Elsevier USA},
  series       = {Journal of Emergency Medicine},
  title        = {Diagnostic Accuracy of History and Physical Examination for Predicting Major Adverse Cardiac Events Within 30 Days in Patients With Acute Chest Pain},
  url          = {http://dx.doi.org/10.1016/j.jemermed.2019.09.044},
  doi          = {10.1016/j.jemermed.2019.09.044},
  volume       = {58},
  year         = {2020},
}