Lack of changes on an electrocardiogram (ECG) performed in patients presenting with chest pain in the emergency department (ED) is often thought to reflect less likelihood of acute coronary syndrome (ACS).
Objective
Identify predictive factors of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in patients who presented to the ED with the chief complaint of acute chest pain and whose initial ECG was normal.
Methods
Prospective, observational, over two years study. We included all patients who met the following criteria: age ≥ 18 years, chief complaint of non-traumatic chest pain, normal ECG, and admission for evaluation for ACS.
The diagnosis of ACS was focused on coronary angiography demonstrating >70% stenosis in a major coronary artery. Patients were divided into ACS and non ACS groups.
We performed an univariate and a multivariate analysis to identify the factors associated with ACS.
Results
Fifty eight patients were included. The mean age was 58 ± 11 years. The sex ratio was 2. 22. Comorbidities n (%): diabetic 30 (52), hypertension 20 (34), known coronaropathy 19 (33) and dyslipedemia 18 (31). Nineteen patients (33%) had elevated troponin. The median TIMI score was 2 [1, 5] and the median GRACE score was 94 [77,108].Thirty-three patients (57%) had a positive angiography.
In multivariate analysis, age ≥65 years (adjusted OR=6.6; 95%CI [1.5 -29]; p=0.01), past medical history of diabetes (adjusted OR=6.1; 95%CI [1.8–20.6];p=0.003), known coronaropathy (adjusted OR =3.5; 95%CI [3.1-26];p=0.02) and a positive troponin level at admission (adjusted OR=7.5; 95%IC [2.1-26]; p= 0.001) were independently associated with the diagnosis of ACS.
Conclusion
Advanced age, history of diabetes or known coronaropathy and positive troponin level at admission are the main factors associated with ACS in patients presenting with an acute chest pain and normal ECG. The early identification of these factors by the emergency physician will improve the management of acute chest pain in patients with normal initial ECG.
