Key result
Sweating had the highest diagnostic odds ratio for acute myocardial infarction (DOR 5.75), while absence of chest wall tenderness was most useful for acute coronary syndrome (DOR 7.73).
Why the study?
Signs and symptoms of ACS and AMI are non-specific, and the last diagnostic meta-analysis evaluating their accuracy dated from 2012.
Do specific signs and symptoms accurately diagnose acute myocardial infarction or acute coronary syndrome in primary care or emergency department settings?
Meta-Analysis (n=72,992)
Do specific signs and symptoms accurately diagnose acute myocardial infarction or acute coronary syndrome in primary care or emergency department settings?
Individual signs and symptoms have limited diagnostic utility for ACS/AMI in low-prevalence settings, though features like sweating, right arm radiation, and absence of chest wall tenderness offer the highest diagnostic value to aid clinical assessment.
Answers are grounded in this paper and cite their sources.
Sweating and absent chest wall tenderness aid AMI/ACS assessment in primary care; extends meta-analytic evidence on highest-value symptoms amid limited overall utility.
BACKGROUND: Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012. METHODS: We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently. RESULTS: We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57-5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64-6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77-11.9)) and sweating (DOR 5.75 (95%CI 2.51-11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7-12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19-19.8)). CONCLUSION: We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners' diagnostic assessment of chest pain in primary care settings.
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Raat et al. (2024) conducted a meta-analysis in Acute coronary syndrome and acute myocardial infarction (n=72,992). Clinical signs and symptoms (e.g., sweating, chest wall tenderness) vs. Reference standard (cardiac biomarkers and ECG) was evaluated on Diagnostic accuracy of sweating for acute myocardial infarction (DOR 5.75, 95% CI 2.51-11.4). Sweating had the highest diagnostic odds ratio for acute myocardial infarction (DOR 5.75), while absence of chest wall tenderness was most useful for acute coronary syndrome (DOR 7.73).
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