Abstract 15745: Electrocardiographic Characteristics of Patients Evaluated at the Emergency Department for a Chief Complaint of Chest Pain
Introduction: Chest pain is the second leading cause of emergency department (ED) visits among US adults. The etiology can include acute coronary syndrome (ACS), cardiopulmonary diseases, or other non-cardiac related causes. Although the 12-lead ECG is the principal tool to evaluate these patients, the prevalence of multiple ECG abnormalities and their clinical value are still poorly characterized. We tested whether there was association between the number of ECG abnormalities and hospital outcomes.
Methods: Non-traumatic chest pain patients were recruited from three UPMC-affiliated hospitals. Digital 12-lead ECGs were obtained at the ED and clinical data were obtained from the electronic records. ECGs were reviewed by a physician blinded to clinical data and course of hospitalization. As per standard practice guidelines, each ECG was read for eighteen abnormalities of interest: atrial fibrillation; heart blocks; axis deviation; atrial enlargement; ventricular hypertrophy; bundle branch blocks; left anterior fascicular block; pathologic Q waves; fragmented QRS; ST elevation; ST depression; T wave inversion; QRS widening; and QT prolongation.
Results: Our sample included 351 patients with mean age 59 (SD 17) years (42% females and 39% blacks). Approximately 20% had ACS. The majority of causes were non-cardiac related (52%) or due to non-ischemic cardiopulmonary disease (29%). Nearly 30% had a repeat ED visit within 30 days of initial evaluation. Patients had a median of 2 (IQ range 1-3) abnormal findings on the initial ECG, with more than 40% having 3 or more abnormalities. The most common abnormalities were QT prolongation (32%), pathological Q waves (29%), and T wave inversion (28%). The least common were right ventricular hypertrophy (0.6%), left atrial enlargement (2.4%), and right axis deviation (4.6%). Older age and the presence of ACS correlated positively with the number of observed ECG abnormalities. The presence of 3 or more ECG abnormalities predicted 30-day repeat ED visits (OR = 1.7 [1.1-2.9]), independent of age, sex, and etiology.
Conclusions: ECG abnormalities are present in most patients with chest pain. The number of ECG abnormalities provides valuable prognostic information to risk stratify this heterogeneous population.
Author Disclosures: M. Alhamaydeh: None. D. Rivero: None. M. Alrawashdeh: None. C. Martin-Gill: None. C. Callaway: None. S.S. Al-Zaiti: None.
- © 2016 by American Heart Association, Inc.