Clinical predictors of acute coronary syndromes in patients with undifferentiated chest pain.
BACKGROUND
Patients with acute, undifferentiated chest pain present a frequent diagnostic challenge to clinicians. Clinical features are often used to determine which patients may have acute coronary syndrome (ACS).


OBJECTIVE
To identify clinical features that independently predict ACS in patients with acute, undifferentiated chest pain.


METHODS
Prospective study of patients enrolled in a randomized controlled trial.


METHODS
The presenting characteristics of participants in the ESCAPE randomized trial of chest pain unit vs. routine care were recorded in a standardized manner. Follow-up consisted of troponin T measurement at 2 days, postal questionnaire at 1 month, and telephone contact at 6 months. ACS was defined as elevated troponin T at 2 days or major adverse cardiac event within 30 days of presentation. Multivariate analysis identified independent clinical predictors of ACS.


RESULTS
ACS was diagnosed in 77 (7.9%) of the 972 patients recruited. The following characteristics were independent predictors of ACS (odds ratio, p): age (1.09, p < 0.001), male gender (8.6, p < 0.001), indigestion or burning-type pain (3.0, p = 0.034), pain radiating to the left (2.4, p = 0.013) or right (5.7, p < 0.001) arm, vomiting (3.5, p = 0.007), and previous (5.1, p < 0.001) or current (3.7, p < 0.001) smoking.


CONCLUSIONS
In addition to previously recognized predictors of ACS, it appears that indigestion or burning type pain predicts ACS in patients attending the emergency department with acute, undifferentiated chest pain. Diagnosis of acute 'gastro-oesophageal' chest pain should be avoided in this setting.
Goodacre
S W
SW
Accident and Emergency Department, Northern General Hospital, Sheffield, UK. s.goodacre@sheffield.ac.uk
Angelini
K
K
Arnold
J
J
Revill
S
S
Morris
F
F
D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003327:Coronary Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013577:Syndrome