Predictors of acute coronary syndrome without ST segment elevation and risk stratification in the chest pain unit Predictores de síndrome coronario agudo sin supradesnivel del ST y estratificación de riesgo en la unidad de dolor torácico. Experiencia en 1.168 pacientes

Gabrielli L.A.; Castro G. P.F.; Verdejo H.E.; McNab P.A.; Llevaneras S.A.; Mardonez J.M.; Corbalan R.L.

Keywords: tests, blood, emergency, risk, patient, markers, prediction, ratio, humans, pain, human, male, aged, health, female, article, coronary, marker, forecasting, discharge, service, chest, acute, assessment, electrocardiography, studies, value, study, hospital, troponin, thorax, middle, of, syndrome, biological, and, I, prospective, Odds, Predictive, Service,


Background: Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis. Aim: To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit. Material and methods: Prospective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression. Results: In a four years period, 1,168 patients aged 62±23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29). Conclusions: Simple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.

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Título de la Revista: REVISTA MEDICA DE CHILE
Volumen: 136
Número: 4
Editorial: Sociedad Médica de Santiago
Fecha de publicación: 2008
Página de inicio: 442
Página final: 450