Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction

Link to article at PubMed

Crit Pathw Cardiol. 2020 Aug 28. doi: 10.1097/HPC.0000000000000241. Online ahead of print.


Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram (ECG) ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia. Chest pain is the determinant symptom, often measured using an 11-point scale (0-10). Greater severity of chest pain is presumed to be associated with a stronger likelihood of a true positive STEMI diagnosis. This retrospective observational cohort study considered consecutive STEMI patients from 5/02/2009-12/31/2018. Analysis of standard STEMI metrics included positive ECG-to-device and first medical contact (FMC)-to-device times, presence of comorbidities, false positive diagnosis, 30-day and 1-year mortality, and 30-day readmission. Chest pain severity was assessed upon admission to the primary percutaneous coronary intervention (PPCI) hospital. We analyzed 1409 STEMI activations (69% male, 66.3 years old ± 13.7 years). Of these, 251 (17.8%) had no obstructive lesion, consistent with false positive STEMI. 466 (33.1%) reported chest pain rating of 0 on admission, 378 (26.8%) reported mild pain (1-3), 300 (21.3%) moderate (4-6), and 265 (18.8%) severe (7-10). Patients presenting without chest pain had a significantly higher rate of false positive STEMI diagnosis. Increasing chest pain severity was associated with decreased time from FMC to device, and decreased in-hospital, 30-day and 1-year mortality. Severity of chest pain on admission did not correlate to the likelihood of a true positive STEMI diagnosis, although it was associated with improved patient prognosis, in the form of improved outcomes, and shorter times to reperfusion.

PMID:32947377 | DOI:10.1097/HPC.0000000000000241

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