Document Detail


Is the initial diagnostic impression of "noncardiac chest pain" adequate to exclude cardiac disease?
MedLine Citation:
PMID:  15573030     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: In patients presenting to the emergency department (ED) with an initial diagnostic impression of noncardiac chest pain, we determine the 30-day incidence of adverse cardiac events and characteristics associated with those events. METHODS: The multicenter, prospectively collected Internet Tracking Registry for Acute Coronary Syndromes (i*tr ACS ) registry of patients with chest pain enrolled from June 1, 1999, to August 1, 2001, was reviewed. We included patients if the physician's initial diagnostic impression was noncardiac chest pain after the medical history, physical examination, and initial 12-lead ECG. ED records, inpatient records, and follow-up results were reviewed for evidence of an adverse cardiac event defined as ST-segment or non-ST-segment elevation myocardial infarction, unstable angina, revascularization, or cardiac death within 30 days. RESULTS: Of 17,737 patients enrolled in i*tr ACS , 2,992 had an initial emergency physician impression of noncardiac chest pain. Of these, 85 (2.8%) patients had definite evidence for an adverse cardiac event. The adverse cardiac event group was older (61.2 versus 47.9 years), more likely to be men (58.6% versus 38.7%), and had a higher Acute Cardiac Ischemia-Time Insensitive Predictive Instrument score (26.1 versus 15.6). Factors associated with adverse cardiac events included hypercholesterolemia, diabetes, history of coronary artery disease, and history of congestive heart failure. CONCLUSION: When the initial impression is noncardiac chest pain, high-risk features such as traditional cardiovascular risk factors or a history of coronary artery disease are associated with adverse cardiac events. In the absence of well-defined criteria, treating physicians should consider further evaluation before diagnosing patients with noncardiac chest pain if these features are present.
Authors:
Chadwick D Miller; Christopher J Lindsell; Sorabh Khandelwal; Abhinav Chandra; Charles V Pollack; Brian R Tiffany; Judd E Hollander; W Brian Gibler; James W Hoekstra
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  44     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2004-12-01     Completed Date:  2005-03-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  565-74     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency Medicine, Wake Forest University, Winston-Salem, NC 27157-1089, USA. cmiller@wfubmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina Pectoris / diagnosis*
Biological Markers / blood
Chest Pain / etiology*
Diagnosis, Differential
Diagnostic Errors
Electrocardiography
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis
Myocardial Ischemia / diagnosis*
Registries
Risk Factors
Chemical
Reg. No./Substance:
0/Biological Markers
Comments/Corrections
Comment In:
Ann Emerg Med. 2005 Jul;46(1):96; author reply 96-7   [PMID:  15988439 ]
Ann Emerg Med. 2004 Dec;44(6):575-6   [PMID:  15573031 ]
Erratum In:
Ann Emerg Med. 2005 Jan;45(1):87

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


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