Key result
Initial STE is linked to ~150% higher odds of positive cardiac markers and short-term adverse events.
Why the study?
Do specific initial ECG findings predict positive cardiac markers and short-term adverse cardiac events in undifferentiated chest pain patients presenting to the emergency department?
Observational
Do specific initial ECG findings predict positive cardiac markers and short-term adverse cardiac events in undifferentiated chest pain patients presenting to the emergency department?
Initial ECG criteria, including ST-segment changes and pathological Q-waves, can effectively predict positive cardiac markers and short-term adverse cardiac events in ED patients with undifferentiated chest pain.
Objectives: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG findings, other than those previously identified in higher-risk populations, would be predictive of cardiac outcomes and positive cardiac markers. Methods: This study used data from a prospectively collected, retrospectively analyzed Internet-based data registry of undifferentiated chest pain patients (i*trACS). Logistic regression modeling was performed to determine the ECG findings that were predictive of 1) positive cardiac markers and 2) short-term adverse cardiac events. Results: ST-segment elevation (STE), ST-segment depression (STD), pathological Q-waves (PQW), and T-wave inversion were associated with increased odds of percutaneous coronary intervention or catheterization, myocardial infarction, or coronary artery bypass grafting. The odds of creatine kinase–MB (CK-MB) measuring positive were increased if STE, STD, or PQW were present [odds ratio (OR) 2.495, 2.582, and 1.295, respectively]. A right bundle branch block tended to decrease the odds of CK-MB measuring positive (OR 0.658). A similar pattern of results was observed for troponin I (OR 3.608 for STE, 3.72 for STD, 1.538 for PQW). Troponin T showed an increased odds of measuring positive if any of STE, STD, left bundle branch block, or T-wave inversion were evident (OR 2.313, 2.816, 1.80, and 1.449, respectively). Conclusions: Initial ECG criteria can be used to predict short-term cardiac outcomes and positive cardiac markers. These findings can be important aids in the risk-stratification and aggressive treatment regimens of chest pain patients presenting to EDs.
No takes yet. Share an insight, caveat, or question.
Blomkalns et al. (2003) conducted an observational in Undifferentiated chest pain. Specific ECG findings (ST-segment elevation, ST-segment depression, pathological Q-waves, T-wave inversion) vs. Absence of specific ECG findings was evaluated on Positive cardiac markers and short-term adverse cardiac events (OR 2.495). Initial ECG criteria, including ST-segment elevation, were associated with increased odds of positive cardiac markers (e.g., CK-MB OR 2.495 for STE) and short-term adverse cardiac events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: