Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis

Abstract

Diagnostic meta-analysis. MethodUsing MEDLINE, CINAHL, EMBASE, tracing references, and by contacting experts, studies were sought out that described one of the 10 signs and symptoms on one or both conditions. Studies were excluded if they were not based on original data. Validity was assessed using QUADAS and all data were pooled using a random effects model. ResultsSixteen of the 28 included studies were about patients who were non-selected. In this group, absence of chest-wall tenderness on palpation had a pooled sensitivity of 92% (95% confidence interval [CI] = 86 to 96) for acute myocardial infarction and 94% (95% CI = 91 to 96) for acute coronary syndrome. Oppressive pain followed with a pooled sensitivity of 60% (95% CI = 55 to 66) for acute myocardial infarction. Sweating had the highest pooled positive likelihood ratio (LR+), ConclusionsBased on this meta-analysis it was not possible to define an important role for signs and symptoms in the diagnosis of acute myocardial infarction or acute coronary syndrome. Only chest-wall tenderness on palpation largely ruled out acute myocardial infarction or acute coronary syndrome in low-prevalence settings.

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

“…Previous reviews could not define an important role for signs and symptoms in general in the diagnosis of coronary artery disease and acute coronary syndromes. [8][9][10] Among the individual variables that were evaluated, age and history of prior myocardial infarction were effective for diagnosing typical angina (coronary artery disease), 9 and the absence of chestwall tenderness on palpation was effective for diagnosing acute coronary syndromes. 8,10 The variable "patient assumes pain is of cardiac origin" was not used in other studies and therefore remains a unique variable in our study population.…”

“…[8][9][10] Predictive scores have also been developed for use in emergency departments, mainly for the diagnosis of acute coronary syndromes. [11][12][13] To what degree these apply in primary care is unknown.…”

Revising the link between proton-pump inhibitors and risk of acute myocardial infarction—a case-crossover analysis

“…In observational studies drug use in general has been reported to increase in the period before acute hospitalization due to a cardiac event suggesting no causal relationship between drug use and the adverse event but rather an effect of unmeasured confounding [8,9]. On the other hand, because of their potential similarity, prodromal symptoms of acute myocardial infarction (AMI) are sometimes interpreted as dyspepsia [10][11][12]; a mistake that represents a common cause of malpractice allegations in primary healthcare [13][14][15]. Further, patients with antecedents of acute coronary syndrome and atherosclerosis habitually take antiplatelet agents like aspirin or clopidogrel to prevent thrombotic complications and, in turn, are co-prescribed PPI to prevent dyspepsia which is a common side effect of antiplatelet therapy [16][17][18].…”

Retrospective analysis of the role and performance of family medicine versus emergency medical services in the pre-hospital management of patients with AMI in Banja Luka

“…As the first doctors to see the patients, they are in very good position to make a proper diagnosis and apply the recommended therapy, which could save patients' lives, especially in rural areas where the nearest hospital is far away. The initial goal is to determine whether the patient needs to be referred for further testing to rule out an АMI (23). Differentiating ischemic from non-ischemic causes is often difficult, and patients with chest pain of ischemic etiology often appear to be well.…”