Prognostic Value of Symptoms During a Normal or Nonspecific Electrocardiogram in Emergency Department Patients with Potential Acute Coronary Syndrome

Details

• Personal Author:
  Brown AM ; Chase M ; Hollander JE ; Pollack CV Jr. ; Robey JL ; Shofer FS
• Description:
  Objectives: Emergency department (ED) patients with symptoms concerning for acute coronary syndrome (ACS) and a normal electrocardiogram (ECG) are at risk for adverse cardiovascular events. The authors hypothesized that patients with a normal or nonspecific ECG during symptoms have a lower risk for ACS than do those who are asymptomatic. Methods: This was a prospective cohort study of ED patients with potential ACS. Outcomes were acute myocardial infarction (AMI), ACS, and 30-day cardiovascular events (death, AMI, revascularization). Fisher's exact test, t-tests, and logistic regression were used for data analysis. Results: Of 2,593 patient visits, 2,007 patients had normal or nonspecific ECG findings. There were 1,196 who had symptoms during ECG, whereas 811 did not. Patients with symptoms at ECG acquisition were younger (49.9 vs. 55.2 years; p < 0.001) and were more likely to be black (70% vs. 64%; p = 0.002), female (63% vs. 58%; p = 0.03), and to have used cocaine (5% vs. 2%; p = 0.004). They were less likely to have hypertension (49% vs. 58%; p < 0.001), and diabetes (22% vs. 17%; p = 0.002). Patients with and without symptoms were equally likely to have AMI (both 2.8%; p > 0.99), ACS (10.1% vs. 11.5%; p = 0.34), and 30-day adverse outcomes (both 5.3%; p > 0.99). After adjustment for baseline cardiovascular-risk factors, odds ratios for patients with symptoms at the time of ECG acquisition were not significantly different for any of the outcomes: AMI (1.1; 95% confidence interval [CI] = 0.6 to 1.9); ACS (1.1; 95% CI = 0.8 to 1.4); or 30-day events (1.2; 95% CI = 0.8 to 1.9). Conclusions: Patients who are symptomatic during acquisition of a normal or nonspecific ECG have rates of adverse cardiovascular events similar to those of patients without symptoms. Clinicians should not rely on the absence of ECG abnormalities during symptoms to help exclude ACS. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Cohort Studies Diagnosis Occupational Health Safety
• Keywords:
  Author Keywords: Acute Coronary Syndrome Cardiovascular Disease Clinical Tests Cohort Studies Diagnostic Tests Electrocardiogram Health Care Medical Treatment Risk Stratification Screening Methods
• ISSN:
  1553-2712
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  13
• Issue:
  10
• NIOSHTIC Number:
  nn:20053534
• Citation:
  Acad Emerg Med 2006 Oct; 13(10):1034-1039
• Contact Point Address:
  Maureen Chase, MD, Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 330 Brookline Avenue, W/CC-2, Boston, MA 02115
• Email:
  mchasel@bidmc.harvard.edu
• Federal Fiscal Year:
  2007
• Performing Organization:
  University of Pennsylvania, Philadelphia
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Academic Emergency Medicine
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:eb3f6b7d47372b441fd00533775ec7850c994d436cb4b2b329cce84601f837c6d85366445f24cdd27886d9cd5c198b383f3107d4f6b72d9e68cc9aa62069adf9
• Download URL:
  https://stacks.cdc.gov/view/cdc/216267/cdc_216267_DS1.pdf
• File Type:
  [PDF - 344.35 KB ]