Patient-related variables predicting acute coronary syndrome following admission for chest pain of possible coronary origin.
OBJECTIVE
Improving risk stratification of patients experiencing acute chest pain with non-revealing electrocardiogram and cardiac biomarkers could reduce missed acute coronary syndrome and avoid unnecessary hospitalization.


METHODS
We assessed the ability of situational, circumstantial, and other patient-related variables in predicting acute coronary syndrome in 921 consecutive patients randomly admitted to this medical department with chest pain of possible coronary origin. A reference group comprised 107 patients referred promptly to the coronary care unit with acute myocardial infarction.


RESULTS
Acute coronary syndrome eventually developed in 219 (23.7%) patients. Age and proportions of male patients and those with diabetes, which were significantly lower in the heterogeneous chest pain group than in the reference group, did not differ when re-evaluation was performed between the latter group and the subgroup of patients who eventually developed acute coronary syndrome. Overweight and a family history of premature coronary artery disease remained significantly higher in the reference group, while prevalence of pre-existing coronary artery disease, previous coronary angiography, and coronary intervention remained significantly lower. Variables most significantly predictive of acute coronary syndrome resulted: pre-existing coronary artery disease [odds ratio (OR) 3.2; 95% confidence interval (CI) 2.17-4.71; P<0.001), older age (OR 1.35; 95% CI 1.17-1.57; P<0.001), male sex (OR 1.77; 95% CI 1.19-2.61; P=0.004), diabetes (OR 1.6; 95% CI 1.11-2.32; P=0.01), self-initiation of pain relief treatment before seeking medical help (OR 1.54; 95% CI 1.07-2.23; P=0.02), and conviction that hospitalization for acute coronary disease was mandatory (OR 1.46; 95% CI 1.03-2.07; P=0.03).


CONCLUSIONS
Easily obtainable patient-related variables might improve risk stratification and assist physicians to decide on policy in the emergency department and upon hospitalization.
Gorelik
Oleg
O
Department of Internal Medicine 'F', Assaf Harofeh Medical Center, Zerifin, Israel. internal6@asaf.health.gov.il
Almoznino-Sarafian
Dorit
D
Yarovoi
Israel
I
Alon
Irena
I
Shteinshnaider
Miriam
M
Chachashvily
Shulamit
S
Modai
David
D
Cohen
Natan
N
D000208:Acute Disease; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D010349:Patient Compliance; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment