Document Detail


Initial presenting electrocardiogram as determinant for hospital admission in patients presenting to the emergency department with chest pain: a pilot investigation.
MedLine Citation:
PMID:  18000960     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Evaluation of chest pain accounts for millions of costly Emergency Department (ED) visits and hospital admissions annually. Of these, approximately 10-20% are myocardial infarctions (MI). HYPOTHESIS: Patients with chest pain whose initial electrocardiogram (ECG) is normal do not require hospital admission for evaluation and management of a possible myocardial infarction. METHODS: The medical records of a consecutive cohort of 250 patients who presented to the ED with chest pain and were admitted by the ED physician to a cardiology inpatient service of an academic tertiary care medical center were reviewed. Reasons for admission to hospital was to rule out an acute coronary syndrome, specifically, myocardial infarction. The initial ECG of each patient was evaluated for abnormalities and compared with the final diagnosis. RESULTS: Of the 75 patients presenting with normal ECGs (normal, upright T waves and isoelectric ST segments), 1 (1.3%) was subsequently diagnosed with a myocardial infarction by Troponin I elevation alone. Of the 55 patients presenting with abnormal ECGs but no clear evidence of ischemia [i.e., left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH)], 2 (3.6%) were diagnosed with MI. Of the 48 patients presenting with abnormal ECGs questionable for ischemia (nonspecific ST and T wave changes that were not clearly ST segment elevation or depression), 7 (14.6%) were diagnosed with an MI. Of the 72 patients who presented with abnormal ECGs showing ischemia (acute ST segment elevation and/or depression), 39 (54.2%) were shown to have evidence for MI. SUMMARY: Patients who presented with normal ECGs (category 1) were extremely low risk for acute myocardial infarction. Patients with abnormal ECGs but no evidence of definite ischemia (category 2) had a relatively low incidence of MI. Patients with abnormal ECGs questionable for ischemia (category 3) had an intermediate risk of acute myocardial infarction. The majority of patients with abnormal ECGs demonstrating ischemia (category 4) were subsequently shown to evolve an acute myocardial infarction. CONCLUSIONS: Patients with chest pain and initial ECGs with ST segment abnormalities suggestive or diagnostic for ischemia, should be admitted to the hospital for further evaluation and management. Patients with ECGs that do not display acute ST segment changes are at a lower risk for acute myocardial infarction than those with acute ST segment changes and should be admitted on the basis of cardiac risk profile. (i.e., age, gender, hypertension, diabetes, smoking, known coronary artery disease, etc.) Patients with normal ECGs (category 1) are at extremely low risk, and it may be acceptable to consider further evaluation on an outpatient basis.
Authors:
Prasanna K Challa; Karen M Smith; C Richard Conti
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  30     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-21     Completed Date:  2008-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  558-61     Citation Subset:  IM    
Affiliation:
Fellowship in Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome
Bundle-Branch Block
Cardiology / methods*
Chest Pain
Electrocardiography / methods*
Emergency Medicine
Female
Heart Conduction System
Hospitalization
Humans
Male
Myocardial Infarction / diagnosis*,  pathology
Pilot Projects
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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