Are there symptom differences in patients with coronary artery disease presenting to the ED ultimately diagnosed with
Michele M Pelter1, Barbara Riegel, Sharon McKinley
1Orvis School of Nursing, University of Nevada, Reno, Mail Stop 134, Reno, NV 89557, USA. mpelter@unr.edu
Insights
In patients with coronary artery disease (CAD), shortness of breath and dizziness indicate non-acute coronary syndrome (ACS). Prior percutaneous coronary intervention, chest pain, or arm pain suggest ACS, aiding emergency department triage.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Triage
Background:
- Coronary artery disease (CAD) management requires accurate differentiation between acute coronary syndrome (ACS) and non-ACS presentations.
- Emergency department (ED) evaluation of chest pain and related symptoms is critical for timely diagnosis and treatment.
Purpose of the Study:
- To compare presenting symptoms in patients with CAD who visit the ED with or without ACS.
- To assess the influence of sex and age on symptom presentation in CAD patients.
Main Methods:
- Secondary analysis of the multicenter randomized controlled PROMOTION trial.
- Comparison of symptoms between patients with CAD presenting to the ED with ACS versus non-ACS.
Main Results:
- Shortness of breath and dizziness were more frequent in non-ACS presentations (33% vs 25% and 11% vs 3%, respectively).
- Chest pain and arm pain were more common in ACS presentations (65% vs 77% and 9% vs 21%, respectively).
- Multivariate analysis identified shortness of breath/dizziness as indicators of non-ACS, while prior percutaneous coronary intervention, chest pain, and arm pain indicated ACS.
Conclusions:
- Symptom patterns differ significantly between ACS and non-ACS presentations in CAD patients.
- Identifying specific symptoms like shortness of breath, dizziness, chest pain, and arm pain, along with prior interventions, can improve ACS triage accuracy.
Objectives:
Symptoms are compared among patients with coronary artery disease (CAD) admitted to the emergency department with or without acute coronary syndrome (ACS). Sex and age are also assessed.
Methods:
A secondary analysis from the PROMOTION (Patient Response tO Myocardial Infarction fOllowing a Teaching Intervention Offered by Nurses) trial, an multicenter randomized controlled trial, was conducted.
Results:
Of 3522 patients with CAD, at 2 years, 565 (16%) presented to the emergency department, 234 (41%) with non-ACS and 331 (59%) with ACS. Shortness of breath (33% vs 25%, P = .028) or dizziness (11% vs 3%, P = .001) were more common in non-ACS. Chest pain (65% vs 77%, P = .002) or arm pain (9% vs 21%, P = .001) were more common in ACS. In men without ACS, dizziness was more common (11% vs 2%; P = .001). Men with ACS were more likely to have chest pain (78% vs 64%; P = .003); both men and women with ACS more often had arm pain (men, 19% vs 10% [P = .019]; women, 26% vs 13% [P = .023]). In multivariate analysis, patients with shortness of breath (odds ratio [OR], 0.617 [confidence interval [CI], 0.410-0.929]; P = .021) or dizziness (OR, .0311 [CI, 0.136-0.708]; P = .005) were more likely to have non-ACS. Patients with prior percutaneous coronary intervention (OR, 1.592 [CI, 1.087-2.332]; P = .017), chest pain (OR, 1.579 [CI, 1.051-2.375]; P = .028), or arm pain (OR, 1.751 [CI, 1.013-3.025]; P <.042) were more likely to have ACS.
Conclusions:
In patients with CAD, shortness of breath and dizziness are more common in non-ACS, whereas prior percutaneous coronary intervention and chest or arm pain are important factors to include during ACS triage.
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