The following is a summary of “Beyond chest pain: Incremental value of other variables to identify patients for an early ECG,” published in the May 2023 issue of Emergency Medicine by Bunney, et al.

Acute coronary syndrome (ACS) is often characterized by chest pain (CP). Still, many patients, particularly women, the elderly, and non-white individuals, who presented to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI) did not report chest pain.

In the retrospective study, researchers analyzed a 5-year sample of 279,132 adult ED patients to investigate the utility of CP alone in predicting ACS. Then, they progressively added other ACS chief complaints, age, and sex to a series of multivariable logistic regression models. Finally, they evaluated the performance of each model in identifying ACS and STEMI cases.

Using CP alone, approximately 8% of patients would be recommended for electrocardiograms (ECGs) with a sensitivity of 61% and specificity of 92%. However, this approach missed around 28.4% of STEMIs. The model, including all variables, identified approximately 22% of patients for ECGs, with a sensitivity of 82% and specificity of 78%, but missed approximately 14.7% of STEMIs. The model combining CP with other ACS chief complaints demonstrated the highest sensitivity (93%) and specificity (55%), identifying approximately 45.1% of patients for ECGs and only missing around 4.4% of STEMIs.

While CP alone exhibited the highest specificity, it lacked sensitivity in identifying ACS and STEMIs. Including other ACS chief complaints improved sensitivity but resulted in a 2.2-fold increase in patients recommended for ECGs. Achieving a 10-minute ECG for all ACS patients to identify STEMIs poses challenges without introducing more complex risk calculations into clinical care.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000712