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04-08-2011 | Cardiology | Article

Degree of chest pain ‘not indicative’ of AMI


Free abstract

MedWire News: The degree of a patient's chest pain does not determine their short-term risk for heart attack or death, a study suggests.

Patients who present to the emergency department (ED) with severe chest pain are no more likely to experience acute myocardial infarction (AMI) at index visit or revascularization, AMI or death at 30 days than those with mild or moderate pain, report Anna Marie Chang (University of Pennsylvania, Philadelphia, USA) and co-authors in the Annals of Emergency Medicine.

The study included 3306 patients (57% women, 66% Black) with a mean age of 51 years who presented to the ED with potential acute coronary syndrome (ACS). Each patient reported the degree of their chest pain on a scale of 0-10, where scores of 9 or 10 represented severe pain.

The authors also stratified patients according to chest pain duration in their analysis, as pain lasting longer than 1 hour has previously been linked to an increased risk for AMI.

The main outcomes of interest were the prevalence of AMI during index visit, and the composite of death, AMI, revascularization including percutaneous coronary intervention and coronary artery bypass graft surgery, at 30 days.

Of the 3084 (93%) patients available for follow-up at 30 days, 34 had died, 105 had undergone revascularization, and 11 had experienced AMI.

After adjusting for confounding variables, an increased prevalence of inhospital AMI was associated with a thrombolysis in myocardial infarction (TIMI) score greater than 5, male gender, and arrival by emergency medical services (EMS; RR=2.00, 1.48, 1.73, respectively).

In addition, the 30-day composite outcome was increased with male gender, White race, and a TIMI score greater than 5 (RR=1.53, 1.43, 2.24, respectively).

However, neither inhospital AMI nor the composite outcome was associated with age, pain lasting longer than 1 hour, or severe pain.

Even though it is common practice for patients with a high pain score to undergo inhospital cardiac evaluation for ACS, the authors say their study demonstrates that this should not necessarily be the case.

"Although pain management is an important issue to address clinically, pain severity itself should not be a factor in evaluating patients' risk for ACS," they conclude.

By Piriya Mahendra

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