Predicting unfavorable outcome in subjects with diagnosis of chest pain of undifferentiated origin - 21/11/11
, Filippo Ottani, MD b, Giulio Marchesini c, Marcello Galvani, MD b, Alberto Vandelli, MD aAbstract |
Background |
Subjects with chest pain and a negative diagnostic workup constitute a problem for emergency physicians. We tested the usefulness of clinical variables in predicting 30-day and 6-month outcome in subjects with chest pain of undifferentiated origin after a negative workup.
Methods |
Chest pain of undifferentiated origin was diagnosed by negative first-line (serial electrocardiograms, troponins assays, and 12- to 24-hour observation) and second-line evaluation (echocardiography, exercise tolerance test, stress scintigraphy, stress echocardiography, coronary angiography). Thirty-day and 6-month outcomes were considered unfavorable in the presence of any of the following: death, acute coronary syndrome, need for urgent coronary revascularization. The variables considered for risk stratification were age, sex, smoking, family history of coronary artery disease, presence of hypertension, high cholesterol levels, diabetes, chronic renal failure, cerebral vascular disease, and history of acute coronary syndrome, percutaneous transluminal angioplasty (PTA), coronary artery by pass graft, and heart failure.
Findings |
Five items (diabetes, chronic renal failure, history of PTA or bypass, history of heart failure) were associated with 30-day unfavorable outcome (31 events/1262 cases; 2.5%). The receiver operating characteristic area of the selected items was 0.726 (95% confidence interval [CI], 0.654-0.798); sensitivity was 90.3% (73.1-95.8) and specificity was 54.8% (52.0-57.6). A similar panel of items (older age, diabetes, chronic renal failure, history of PTA) predicted an unfavorable 6-month outcome (90 subjects [7.1%], with lower accuracy (receiver operating characteristic area, 0.610 [95% CI, 0.594-0.627, P < .05]; sensitivity, 98.9% [95% CI, 93.1–99.6]; specificity, 21.6% [95% CI, 19.4–23.9]).
Interpretation |
In subjects with chest pain of undifferentiated origin, the risk of unfavorable outcome cannot be accurately predicted by the selected clinical items.
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| ☆ | Contributors: AF conceived the study, wrote the protocol, coordinated the data collection, contributed to interpretation of the results, and wrote the paper. OF contributed to interpretation of the results and critical review of the paper. GM contributed to study design, interpretation of the results, and co-wrote the paper. MG contributed to interpretation of the results and critical review of the paper and co-wrote the paper. AV contributed to study design, interpretation of the results, and critical review of the paper. All authors approved the final version of the paper. |
| ☆☆ | Conflict of interest: All authors warrant to have no conflict of interest in connection with the article; they have access to all data in the study and they held final responsibility for the decision to submit for publication. |
| ★ | Funding. None. |
Vol 30 - N° 1
P. 61-67 - janvier 2012 Retour au numéro
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