Abstract 26: Traditional Cardiac Risk Factors and Characteristics of the Cardiac History Are Associated With 30-Day Cardiac Events in Emergency Department Patients With Chest Pain
Objectives: Previous studies have not shown that traditional cardiac risk factors aid in the prediction of short-term cardiac events in patients who present to the emergency department (ED) with chest pain. We sought to reevaluate this postulate as part of a multicenter prospective study.
Methods: We conducted a multicenter prospective cohort study in 3 academic EDs over a 36-month period. Patients over 24 years of age with a primary complaint of chest pain and possible acute coronary syndrome were enrolled. On-duty physicians completed standardized data collection forms prior to diagnostic testing using standard definitions. The pre-specified primary adjudicated outcome was acute myocardial infarction, revascularization, or death within 30 days. The unadjusted association between cardiac risk factors/characteristics from the cardiac history and cardiac events was assessed with univariate logistic regression, and adjusted associations were determined with multiple logistic regression.
Results: We enrolled 2,718 patients. Mean age (SD) was 60.0 (14.9) years, and 53% were male. There were 336 (12.4%, 95% CI 11.2%–13.4 %) patients who had a cardiac event within 30 days. All the elements of the cardiac history and cardiac risk factors with the exception of “family history of cardiac disease” were significantly associated with cardiac events by univariate analysis (see table). After adjusting for age, sex, ST-segment deviation and initial cardiac troponin, the odds ratios for hypertension, hypercholesterolemia, and known coronary artery disease remained significant.
Conclusions: In this large multicenter study several traditional cardiac risk factors and elements of the cardiac history were associated with 30-day cardiac events. When evaluating patients with chest pain in the ED, incorporating traditional risk factors and characteristics of the cardiac history in the evaluation appears warranted.
- © 2010 by American Heart Association, Inc.