The early risk stratification of the patients with acute chest pain

Abstract

Objective This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram (ECG), cardiac injury markers and the number of accompanying traditional risk factors(smoking, obesity, hyperlipemia, hypertension, diabetes), and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome(ACS) admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram (ECG), cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups: Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes(without abnormal cardiac injury biomarkers). Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and > 2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only ≤ 2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS(the specificity being 90.7%). The mortality of group 3 was higher compared with group 4(69.6% vs 53.3%), however the P value was more than 0.05 and didn't show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation ( r = 0.202, P = 0.044) with the number of stenosis being more than 50% of the artery diameter. Multiple linear regression showed the hypertension had a significant correlation with the number of the diseased regions(P = 0.014). Conclusions The risk stratification based on the symptom, ECG, cardiac injury markers and accompanying traditional risk factors is both important and available in practice. It is unsuitable for patients with a normal ECG and cardiac injury markers to differentiate ACS from non-cardiac chest pain relying only on the number of the accompanying traditional risk factors. However we found the number of the risk factors can indicate the disease severity.