[Predictors of acute coronary syndrome without ST segment elevation and risk stratification in the chest pain unit].
BACKGROUND
Nearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis.


OBJECTIVE
To select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit.


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.
Gabrielli
Luigi A
LA
Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
Castro
Pablo F
PF
Verdejo
Hugo E
HE
McNab
Paul A
PA
Llevaneras
Silvana A
SA
Mardonez
José M
JM
Corbalán
Ramón L
RL