Key result
Classic chest pain features show limited predictive value for ruling AMI in or out.
Why the study?
The predictive value and diagnostic performance of clinical features in diagnosing coronary syndromes in patients with acute, undifferentiated chest pain were uncertain.
Do specific clinical features predict acute myocardial infarction or acute coronary syndrome in patients presenting with acute, undifferentiated chest pain?
Comparison
Clinical features predicting AMI or ACS
Design
Prospective observational cohort study
Authors
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Few clinical features reliably predict ACS; supports objective testing over history alone and leaves open refined risk tools.
Observational (n=893)
Do specific clinical features predict acute myocardial infarction or acute coronary syndrome in patients presenting with acute, undifferentiated chest pain?
Effect estimate: LR 4.07
Clinical features alone have limited predictive value for diagnosing AMI or ACS in patients presenting with acute, undifferentiated chest pain and a nondiagnostic ECG, suggesting they should not be heavily relied upon for triage.
Goodacre et al. (2002) conducted an observational in acute, undifferentiated chest pain (n=893). Clinical features (e.g., exertional pain, pain radiation) vs. Absence of specific clinical features was evaluated on Acute myocardial infarction (AMI) by World Health Organization criteria (LR 4.07). Clinical features such as exertional pain (LR 2.35) and pain radiating to the shoulder or arms (LR 4.07) have limited predictive value for diagnosing acute myocardial infarction.
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