Key result
Forward-leaning tripod posture at ED arrival linked to ~7.5-fold higher odds of ACS.
Why the study?
Whether spontaneous body posture at emergency department arrival is associated with ACS and improves discrimination beyond established clinical risk scores was uncertain.
Does spontaneous body posture at emergency department arrival associate with acute coronary syndrome and improve model discrimination beyond HEART and TIMI scores in adults evaluated for possible ACS?
Cohort (n=225)
Cardiologists blinded to posture adjudicated ACS
No
Does spontaneous body posture at emergency department arrival associate with acute coronary syndrome and improve model discrimination beyond HEART and TIMI scores in adults evaluated for possible ACS?
Spontaneous tripod/forward-leaning and arm-supported postures at emergency department arrival are strongly associated with acute coronary syndrome and provide incremental discrimination over HEART and TIMI scores, though external validation is needed.
Answers are grounded in this paper and cite their sources.
Tripod posture association with ACS should not change ED practice; leaves open incremental value beyond HEART/TIMI pending validation.
OBJECTIVES: To determine whether spontaneous body posture at emergency department arrival is associated with acute coronary syndrome (ACS) and whether its addition improves apparent model discrimination beyond established clinical risk scores. METHODS: We conducted a prospective, single-center observational study using convenience sampling during investigators' 24-h clinical shifts, including nights and weekends. Adults undergoing evaluation for possible ACS were eligible. Spontaneous posture was recorded on an ED stretcher within 1-2 min of arrival or transfer, before clinician-directed positioning, using six categories. Cardiologists blinded to posture adjudicated ACS. Firth regression adjusted for age, sex, and coronary artery disease. Sensitivity analyses accounted for arrival mode and excluded ST-segment elevation myocardial infarction (STEMI). HEART and TIMI discrimination analyses excluded STEMI and used bootstrap correction for optimism. RESULTS: Among 225 participants, 64 (28.4%) had ACS: 12 STEMIs, 48 non-ST-segment elevation myocardial infarctions, and four cases of unstable angina. Compared with leaning back, tripod/forward-leaning posture (adjusted odds ratio [aOR], 7.54; 95% confidence interval [CI], 2.46-25.48) and arm-supported posture (aOR, 6.91; 95% CI, 1.83-29.16) were associated with higher ACS odds. The global posture association persisted after arrival-mode adjustment and STEMI exclusion. In the separate 30-patient reliability sample, unweighted Cohen's κ was 0.945 (95% CI, 0.725-1.000). Among 213 patients without STEMI, adding posture increased the optimism-corrected area under the curve from 0.8709 to 0.8950 for HEART and from 0.8208 to 0.8800 for TIMI. CONCLUSIONS: Spontaneous posture was associated with ACS in this cohort, including after STEMI exclusion. Posture provided incremental discrimination beyond HEART and TIMI, but ACS specificity and clinical decision benefit remain unestablished. External validation is required before clinical use.
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Yorgun et al. (2026) conducted a cohort in Suspected acute coronary syndrome (ACS) (n=225). Spontaneous body posture at emergency department arrival (e.g., tripod/forward-leaning or arm-supported posture) vs. Leaning back posture was evaluated on Adjudicated acute coronary syndrome (ACS: STEMI, NSTEMI, or unstable angina) (aOR 7.54, 95% CI 2.46-25.48). Tripod/forward-leaning posture at ED arrival was associated with higher odds of ACS vs leaning back.
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