title: Pre-hospital prediction of death or cardiovascular complications during hospitalisation and death within one year in suspected acute coronary syndrome patients.
abstract: OBJECTIVE
  To identify pre-hospital predictors of a) death or the development of cardiovascular complications during hospitalisation (primary objective) and b) all-cause death during one year of follow-up (secondary objective), in chest pain patients with suspected acute coronary syndrome (ACS).
  
  
  METHODS
  A prospective study that comprised patients in western Sweden, who were transported to hospital by the emergency medical service (EMS) due to chest pain and suspected ACS. Multiple logistic regression was used to identify independent predictors of adverse outcomes.
  
  
  RESULTS
  Among all 1600 eligible patients, 21% died or had a cardiovascular complication during hospitalisation and 10% died during one year of follow-up. Nine factors were identified pre-hospitalisation as independent predictors of death or cardiovascular complications during hospitalisation. They were increasing age, a history of congestive heart failure, nausea and/or vomiting, rapid breathing rate, low oxygen saturation, high heart rate, together with ST-segment elevation, ST-segment depression and right bundle branch block on the pre-hospital electrocardiogram (ECG). For the secondary objective of death during one year of follow-up, the following five factors were identified as independent predictors: increasing age, a history of congestive heart failure, dyspnea, low oxygen saturation and left bundle branch block on the pre-hospital ECG.
  
  
  CONCLUSIONS
  In the pre-hospital setting of chest pain and suspected ACS, we identified nine predictors of the primary adverse outcome. They were factors representing previous history, symptoms and ECG findings. This information may contribute to the development of a decision support system for the EMS, which then needs to be clinically tested.
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: nguyendangthangvietnam@gmail.com.
authors.forename: Nguyen Dang
authors.initials: ND
authors.lastname: Thang
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
authors.forename: Björn Wilgot
authors.initials: BW
authors.lastname: Karlson
authors.affiliation: School of Health Sciences, Research Centre PreHospen, University of Borås, The Pre-hospital Research Centre of Western Sweden, Sweden.
authors.forename: Birgitta Wireklint
authors.initials: BW
authors.lastname: Sundström
authors.affiliation: Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; School of Health Sciences, Research Centre PreHospen, University of Borås, The Pre-hospital Research Centre of Western Sweden, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D002423:Cause of Death / Q000639:trends; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: Cardiovascular complications; Chest pain; Emergency medical services; Mortality; Pre-hospital ECG; Prediction