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Acute Chest Pain: Diagnostic Accuracy and Pre-hospital Use of Anticoagulants and Platelet Aggregation Inhibitors.
- Source :
- Deutsches Ärzteblatt International; 5/5/2023, Vol. 120 Issue 18, p317-323, 8p
- Publication Year :
- 2023
-
Abstract
- Background: Acute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome, but often has a non-cardiac cause. The recommendations regarding pre-hospital drug treatment of patients with aCP are ambiguous. Methods: A retrospective cohort study was conducted of 822 patients with aCP who were attended by emergency physicians. The cause of aCP was classified as follows: acute coronary syndrome without ST-segment elevation (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmias, musculoskeletal, or other. The suspected and discharge diagnoses were compared, and the pre-hospital administration of acetylsalicylic acid (ASA) and unfractionated heparin (UFH) was analyzed. Furthermore, the parameters that improved diagnostic accuracy were investigated. Results: The positive predictive value of the diagnosis assigned by the emergency physician (EP diagnosis) was 39.7%. NSTE-ACS was the most commonly suspected cause of aCP (74.7%), but was confirmed after hospital admission in only 26.3% of patients. ASA was administered in 51%, UFH in 55%, and both substances in 46.4% of cases. A large proportion of patients received anticoagulants in the pre-hospital setting although the discharge diagnosis was not NSTE-ACS: ASA 62.9%, UFH 66.0%, both substances 56.5%. Conclusions: ASA and UFH are often given to EP-accompanied patients with aCP despite the low accuracy of diagnosis in the pre-hospital setting. Pre-hospital measurement of high-sensitivity troponin T (hs Trop-T) might improve discrimination between NSTE-ACS and other causes of aCP. This is important, as the current guidelines contain no clear recommendations for pre- hospital drug treatment in NSTE-ACS. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 18660452
- Volume :
- 120
- Issue :
- 18
- Database :
- Supplemental Index
- Journal :
- Deutsches Ärzteblatt International
- Publication Type :
- Academic Journal
- Accession number :
- 165629144
- Full Text :
- https://doi.org/10.3238/arztebl.m2023.0065