Key result
In patients presenting to the ED with chest pain, ACS was diagnosed in 38.9% of high-risk and 33.8% of intermediate-risk patients, with no ACS cases found in the low-risk group.
Why the study?
In the ED, electrocardiograms may be overutilized even in patients with low-risk factors for ACS.
Does clinical risk stratification predict the diagnostic utility of ECG for acute coronary syndrome in patients presenting with chest pain to the emergency department?
Observational (n=313)
Does clinical risk stratification predict the diagnostic utility of ECG for acute coronary syndrome in patients presenting with chest pain to the emergency department?
ECG has zero diagnostic yield for ACS in low-risk chest pain patients, suggesting it can be safely omitted to conserve emergency department resources.
May support omitting ECG in low-risk chest pain; leaves open need for prospective validation before practice change.
Background: In emergency department (ED), though electrocardiogram (ECG) is obtained for both typical and atypical chest pain, at certain times, it is overutilized even in patients with low-risk factors for acute coronary syndrome (ACS). This study aimed to assess the utility of an ECG in patients presenting with chest pain to the ED. Materials and Methods: This prospective study included patients presenting with chest pain to the ED during August and September 2018. Following their initial assessment at triage, patients were grouped into high-, intermediate- and low-risk categories based on their risk factors for an ACS. ECGs were acquired and categorized into ACS and non-ACS pattern and their utility in each group was assessed. Results: This study cohort contains 313 patients with a male predominance 59.1%. The mean age was 52.6 ± 15.2 years. Typical chest pain was prominent in 95 (30.4%) patients. The incidence of ischemic and structural heart diseases was 53 (16.9%) and 31 (9.9%), respectively. ACS was diagnosed in 92 (29.3%) patients; among them, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina were noted to be 51 (16.3%), 27 (8.6%), and 14 (4.5%), respectively. The incidence of ACS based on risk category classification was as follows: high risk 38.9% (44/113) and intermediate risk 33.8% (48/142) and no patients in low risk had ACS. Conclusions: ECG though a useful screening test to diagnose ACS, should be used judiciously in patients with low risk of ACS to optimally utilize the limited resources in ED.
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Sanjay et al. (2023) conducted an observational in Chest pain (n=313). Electrocardiogram (ECG) was evaluated on Incidence of acute coronary syndrome (ACS) by risk category. In patients presenting to the ED with chest pain, ACS was diagnosed in 38.9% of high-risk and 33.8% of intermediate-risk patients, with no ACS cases found in the low-risk group.
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