Very early risk modeling in patients with chest pain based on the pattern on admission ECG

Abstract

OBJECTIVES: The aim was to investigate the prognostic accuracy of admission ECG and its usefulness in determining the population at the highest risk of worse outcomes. BACKGROUND: Fast and accurate assessment of chest pain patients remains a challenge for clinicians. Electrocardiogram (ECG) is performed in each case of suspicion of the cardiac origin of chest pain. METHODS: Consecutive adult chest pain patients with suspicion of acute myocardial infarction (AMI) were enrolled in the study. The prognostic value of admission ECG changes alone and in combination with other clinical variables (cardiac troponin, diagnosis of AMI) were analyzed for the incidence of major adverse cardiac events (MACE) in a one-year observation. RESULTS: The ischemic pattern on admission ECG was a single risk factor of MACE (HR 2.996 95% CI 1.31-6.86, p = 0.009), contrary to the single admission high-sensitivity cardiac troponin T assay (hs-cTnT) (HR 1.79 95% CI 0.695-4.61, p = 0.23). The highest risk of MACE was identifi ed in case of the presence of both ischemic-ECG and positive hs-cTnT (HR 3.19 95% CI 1.496-6.81, p = 0.003). CONCLUSIONS: The presence of ischemic changes in ECG in chest pain population with AMI suspicion increases the risk of MACE. The group at highest risk of MACE can by identifi ed by the additional stratifi cation with the admission single hs-TnT measurement (Tab. 2, Fig. 4, Ref. 40).