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Year : 2023  |  Volume : 21  |  Issue : 1  |  Page : 44-49

The utility of an electrocardiogram in high-, intermediate-, and low-risk patients presenting with chest pain to emergency department

1 Department of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Abraham Speedie
Department of Cardiology, Christian Medical College, Vellore - 632 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_102_22

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Background: In emergency department (ED), though electrocardiogram (ECG) is obtained for both typical and atypical chest pain, at certain times, it is overutilized even in patients with low-risk factors for acute coronary syndrome (ACS). This study aimed to assess the utility of an ECG in patients presenting with chest pain to the ED. Materials and Methods: This prospective study included patients presenting with chest pain to the ED during August and September 2018. Following their initial assessment at triage, patients were grouped into high-, intermediate- and low-risk categories based on their risk factors for an ACS. ECGs were acquired and categorized into ACS and non-ACS pattern and their utility in each group was assessed. Results: This study cohort contains 313 patients with a male predominance 59.1%. The mean age was 52.6 ± 15.2 years. Typical chest pain was prominent in 95 (30.4%) patients. The incidence of ischemic and structural heart diseases was 53 (16.9%) and 31 (9.9%), respectively. ACS was diagnosed in 92 (29.3%) patients; among them, ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina were noted to be 51 (16.3%), 27 (8.6%), and 14 (4.5%), respectively. The incidence of ACS based on risk category classification was as follows: high risk 38.9% (44/113) and intermediate risk 33.8% (48/142) and no patients in low risk had ACS. Conclusions: ECG though a useful screening test to diagnose ACS, should be used judiciously in patients with low risk of ACS to optimally utilize the limited resources in ED.

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