Frisch A, et al. - Herein, undifferentiated emergency medical services (EMS) patients reporting chest pain in the absence of ST-segment elevation (STEMI) on EKG were assessed to determine the factors related to the requirement for advanced cardiac care in these subjects. Researchers succeed at identifying several considerable factors, which were potentially predictive and broad, for risk stratification of prehospital patients reporting chest pain. Furthermore, the factors supported the need for other objective factors that could augment prediction of patients who may benefit from early advanced cardiac care.

Methods

• Excluding patients with STEMI on prehospital electrocardiogram, this retrospective analysis included all adult patients, reporting atraumatic chest pain from a single EMS agency, presenting to a single, urban hospital over a 10-year period.
• For all patients, patient demographics, chest pain characteristics and prehospital factors were abstracted.
• Those patients that required advanced cardiac care were identified and regression analysis was carried out to determine associated factors.

Results

• Researchers analyzed a total of 956 charts and 193 patients (20.2%) met the primary composite outcome.
• Findings demonstrated that among patients of the outcome group, 185 patients (95.9%) had coronary artery disease documented on cardiac catheterization, CABG was performed on 22 patients (11.4%), and in-hospital death was reported in 7 patients (3.6%).
• Age (1.02), male gender (1.65), history of MI (1.47), PCI (1.66), hyperlipidemia (1.40), diaphoresis (1.51), home aspirin (1.53), and improvement with EMS treatment (1.60) were documented as the most significant variables (multivariable IRR).