39 Value of 2D-Echocardiography in Patients With Chest Pain and Suspected Acute Coronary Syndromes

Abstract

Chest pain is a major reason for admission to the emergency department (ED). Traditional risk stratification strategy still results in a proportion of patients being inadequately evaluated and discharged. Echocardiogram is a potential tool to optimize this evaluation. We sought to evaluate the impact of echocardiography on the outcome of patients with suspected acute coronary syndromes. We prospectively studied 735 chest pain patients referred to ED with suspected acute coronary syndrome. Of those, 409 patients (Group I) had an echocardiogram performed at presentation with regional and global left ventricular function (VF) information provided to the attending physician. Those without an echo composed Group II. Patients were followed for 12-months regarding survival and percutaneous coronary intervention. Information on traditional risk stratification factors was available for all. Echocardiogram was performed at presentation in 55.7% of patients. Group I (2.9/10.0; 95%CI 2.0;3.9) had lower unadjusted mortality rate than Group II (4.9/10.0;95%CI 3.6;6.4) (logrank test p=0.01). The difference persisted significant after adjustment for a wide range of covariates (HR 0.50 - 95%CI 0.31;0.82). Having an echo implied greater odds for percutaneous coronary intervention among patients without ST elevation (2.57-95%CI 1.23; 5.37). Information about global VF was associated with lower HR for death even after adjustment (0.78-95%CI 0.65; 0.92). Global VF had an incremental value over traditional risk stratification (24.0 × 31.1global chi-square; p<0.05). Echocardiogram at presentation of patients with suspected acute coronary syndrome has shown an incremental value over traditional risk stratification and was significantly associated with increased survival. It is likely that the additional information prompts the physicians to a more aggressive therapeutic approach.