Abstract 10435: A Plea for Inclusion of Surface Echocardiography for Acute Coronary Syndrome in the Advanced Cardiac Life Support Algorithm

Abstract

Background: The AHA/ACC guidelines algorithm for Acute Coronary Syndrome (ACS) does not include echocardiographic evaluation in the assessment of chest pain. Such patients may be subjected to interventions based on ECG leading invasive procedures which may prove unnecessary. This study was performed to determine if a bedside echocardiography would help identify the conditions that do not need intervention and might possibly change the treatment pathway at the right time. Methods: In a prospective observational study design, adult patients presenting to acute emergency care with chest pain were included in the study. Patients exhibiting a significant ST change on a 12-lead ECG were subjected to bedside echocardiography, i.e. 2D transthoracic echocardiography (2D-TTE) The findings of echocardiography were correlated with ECG and coronary angiography for possible percutaneous coronary intervention. Results: Among the 385 patients in the study, 312 suffered acute coronary syndrome. In 18.7% patients presented to acute emergency care with chest pain, ST-T changes and were found to have causes other than ACS; and bedside echocardiography (2D-TTE) was able to identify 90.4% of those cases. From this study we conclude that bedside echocardiography had high specificity (90.4%) and sensitivity (97.43%) in identifying regional wall motion abnormality (RWMA) due to ACS and exclude non-ischemic causes of chest pain. Conclusion: Bedside echocardiography is recommended in patients with chest pain and ST-segment abnormality to avoid unnecessary delay in diagnosis and invasive interventions in non-acute coronary syndrome (ACS). Hence it is reasonable to include bedside echocardiography in either box 3 or 4 in the ACS algorithm.