CLINICAL-FEATURES OF EMERGENCY DEPARTMENT PATIENTS PRESENTING WITH SYMPTOMS SUGGESTIVE OF ACUTE CARDIAC ISCHEMIA - A MULTICENTER STUDY

Identification of patients with acute cardiac ischemia (ACI) remains c hallenging. The object of this study was to examine the role of clinic al findings in the diagnosis/triage of emergency department (ED) patie nts with symptoms suggestive of ACI. The study was designed as a secon dary data analysis of a multicenter prospective controlled clinical tr ial. It was set in 10 midwest, southeast, and northeast U.S. hospitals , and 10,689 patients with chest pain or other symptoms suggesting ACI presenting from May 1993 to December 1993, participated. The results indicated that ACI patients were more likely to have chest pain as a c hief complaint or presenting symptom (P = 0.001). The presenting sympt om of nausea was more commonly associated with a final diagnosis of AC I (P = 0.003). Shortness of breath as the chief complaint and presenti ng symptoms of abdominal pain, nausea, dizziness, and fainting were le ss frequent among patients with a final diagnosis of ACI (P = 0.001). A past history of diabetes mellitus, myocardial infarction, or angina pectoris was more frequently associated with a final diagnosis of ACI (P = 0.001). A lower pulse rate in patients with a final diagnosis of ACI (P = 0.001) was not considered clinically significant. Median firs t and highest systolic blood pressures (SBPs) were higher, median lowe st SBPs were lower, median diastolic blood pressure of the lowest SBPs were lower, and initial and highest pulse pressures were wider in pat ients with a final diagnosis of ACI (P = 0.001). On arrival, these blo od pressure variables in AMI patients, subsequently classified as Kill ip class 4, were above the threshold for this classification. pales we re more commonly present in patients with a final diagnosis of ACI (P = 0.001). Al primary ST-segment abnormalities, Q waves, and T-wave abn ormalities, except T-wave flattening, were seen more frequently in pat ients with a final diagnosis ACI (P = 0.001). Normal ECGs were more fr equently associated with a non-ACI final diagnosis, yet 20% of AMI pat ients and 37% of Unstable Angina Pectoris (UAP) patients had normal EC Gs. It can be concluded that certain clinical features can help to ide ntify ED patients with ACI. Initially normal ECGs can be seen in 20% o f patients with AMI and 37% of patients with UAP. Patients with ACI ca n present with ''normal'' blood pressures and develop cardiogenic shoc k. Clinical outcome data for ACI patients are presented.