Introduction:It is often believed that chest pain relieved by nitroglycerin is indicative of coronary artery disease origin. Objective: To determine if relief of chest pain with nitroglycerin can be used as a diagnostic test to help differentiate cardiac chest pain and non-cardiac chest pain. Design: Prospective observational cohort study with a 4-week follow-up of patients enrolled. Setting: Academic tertiary care hospital, with 60 000 visits/year. Inclusion criteria: Adult patients presenting to the emergency department with active chest pain who received nitroglycerin and were admitted for chest pain. Exclusion criteria: Patients with acute myocardial infarction diagnosed after obtaining an ECG, patients whose chest pain could not be quantified, those for whom no cardiac work-up was done, or those who received emergent cardiac catheterization. Results: 270 patients were enrolled. Nitroglycerin relieved chest pain in 66% of the subjects. The diagnostic sensitivity of nitroglycerin to determine cardiac chest pain was 72% (64%-80%), and the specificity was 37% (34%-41%). The positive likelihood ratio for having coronary artery disease if nitroglycerin relieved chest pain was 1.1 (0.96-1.34). Telephone follow-up at 4 weeks was performed, with a 95% follow-up rate. Conclusions: Relief of chest pain with nitroglycerin is not a reliable diagnostic test and does not distinguish between cardiac and non-cardiac chest pain. RÉSUMÉ Introduction :On croit souvent que la douleur thoracique soulagée par la nitroglycérine indique que cette douleur est attribuable à une insuffisance coronarienne. Objectif : Déterminer si le soulagement de la douleur thoracique à l'aide de la nitroglycérine peut servir de test diagnostique permettant de différencier la douleur thoracique d'origine cardiaque de la douleur d'origine non cardiaque. Méthodologie : Étude prospective par observation de cohortes avec un suivi après 4 semaines des patients inclus dans l'étude. Cadre : Hôpital universitaire de soins tertiaires recevant 60 000 visites/année. Critères d'inclusion : Les patients adultes s'étant présentés à l'urgence pour une douleur tho- ORIGINAL RESEARCH • RECHERCHE ORIGINALE ADVANCES
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