Can Electrocardiographic Criteria Predict Adverse Cardiac Events and Positive Cardiac Markers?

Abstract

Objectives: To determine electrocardiogram (ECG) predictors of positive cardiac markers and short-term adverse cardiac events in an undifferentiated chest pain population presenting to emergency departments (EDs). The authors hypothesized that specific ECG findings, other than those previously identified in higher-risk populations, would be predictive of cardiac outcomes and positive cardiac markers. Methods: This study used data from a prospectively collected, retrospectively analyzed Internet-based data registry of undifferentiated chest pain patients (i*trACS). Logistic regression modeling was performed to determine the ECG findings that were predictive of 1) positive cardiac markers and 2) short-term adverse cardiac events. Results: ST-segment elevation (STE), ST-segment depression (STD), pathological Q-waves (PQW), and T-wave inversion were associated with increased odds of percutaneous coronary intervention or catheterization, myocardial infarction, or coronary artery bypass grafting. The odds of creatine kinase-MB (CK-MB) measuring positive were increased if STE, STD, or PQW were present [odds ratio (OR) 2.495, 2.582, and 1.295, respectively]. A right bundle branch block tended to decrease the odds of CK-MB measuring positive (OR 0.658). A similar pattern of results was observed for troponin I (OR 3.608 for STE, 3.72 for STD, 1.538 for PQW). Troponin T showed an increased odds of measuring positive if any of STE, STD, left bundle branch block, or T-wave inversion were evident (OR 2.313, 2.816, 1.80, and 1.449, respectively). Conclusions: Initial ECG criteria can be used to predict short-term cardiac outcomes and positive cardiac markers. These findings can be important aids in the riskstratification and aggressive treatment regimens of chest pain patients presenting to EDs.

Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes

“…For these final outcomes, it represents a less powerful risk stratification tool than biomarkers or even the initial ECG. [76][77][78][79][80] In particular, no single element of the chest pain history conveys a powerful enough likelihood ratio to safely allow the clinician to discharge a patient without some additional testing. Despite this limitation, the chest pain history is of value and conveys useful information.…”