Title: A study of clinical profile of low risk Acute Coronary syndrome in a teaching tertiary care hospital - A prospective observational study
Authors: Zahid Shaikh, Daniel S. S., Sumalya Tripathi, Shinde V. S., Avinav Luthra, Sonali Patil, Arjun H. M., Suhrith Bhattaram
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.13
Abstract
The study is chosen to help understand the current state of knowledge regarding the clinical profile of low risk Acute Coronary Syndrome (ACS) and to generate data for future recommendations. 100 patients presenting to the Emergency Department (ED) with acute onset chest pain with normal electrocardiogram (ECG) and negative cardiac biomarkers and with alternative diagnosis less likely were enrolled for a prospective observation and evaluation. All the patients underwent periodic biomarkers and serial ECGs. Endpoint of the study was either the diagnosis of ACS or a cardiologist examination confirming a low risk ACS. Out of 100 patients 4 patients subsequently were diagnosed with ACS and managed accordingly. Factors such as age < 40 years (sensitivity 100% with CI 94.48%-100%, specificity 11.43%, PPV 67.71%, NPV 100%, accuracy 69%), female sex (sensitivity 66.67% with CI 56.31%-75.96%, specificity 25%, PPV 95.52%, NPV 3%, accuracy 65%), sharp nature of pain (sensitivity 9.38% with CI 4.38%-17.05%, specificity 100%, PPV 100%, NPV 4.4%, accuracy 13%) and pain defined as slightly suspicious by the examining physician (sensitivity 91.67% with CI 84.24%-96.33%, specificity 100%, PPV 100%, NPV 33.33%, accuracy 13%) were associated with high likelihood of low risk ACS. Pulse, respiration and saturation of all the patients were well maintained. Although heart rate has been positively correlated with ACS in previous studies our study showed that it has little correlation in low risk ACS cases. Only variable which had variance was systolic blood pressure with a standard deviation of 16. The mean systolic blood pressure was 127.62 mm of Hg.
Keywords: low risk, low probability acute coronary syndrome, clinical profile.
References
- Ramana Rao GV, Rajanarsing Rao HV, Reddy GK, et al. Epidemiological study on cardiac emergencies in Indian states having GVK Emergency Management and Research Institute services. J Soc Health Diabetes (2016); 4:121-6.
- Sharma M, Ganguly NK. Premature coronary artery disease in Indians and its associated risk factors. Vasc Health Risk Manag. (2005) ;1:217–25.
- Than M, Flaws D, Sanders S, et al. Development and validation of the emergency department assessment of chest pain score and 2 h accelerated diagnostic protocol. Emerg Med Australas. (2014) ; 26:34–44.
- Vivek Chauhan, Pavitra Kotini Shah, Sagar Galwankar, et al. The 2017 International Joint Working Group recommendations of the Indian College of Cardiology, the Academic College of Emergency Experts, and INDUSEM on the management of low-risk chest pain in emergency departments across India. J Emerg Trauma Shock. Apr-Jun; 10(2) (2017): 74–81.
- Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation; (2010) 122 (17):1756–1776.
- Ashish Akshay Bedi, Ankit Gaur, et al. Risk factors and clinical profile of ischemic heart disease in north India. Asian Journal of Pharmacy and Pharmacology (2018);4(6): 846-851.
- Udit Narang, Ankit Gupta, et al. Risk factors and demographic profile in acute myocardial infarction: a prospective study from tertiary care rural hospital in North India. International Journal of Contemporary Medical Research (2018) ;5(6):F14-F21.
- Milan Gupta, Narendra Singh, et al. South Asians and Cardiovascular Risk What Clinicians Should Know. Circulation (2006); 113:e924-e929.
- U M Nagamalesh, T Abhinay, et al. Clinical Profile of Young Indian Women Presenting with Acute Coronary Syndrome. J Clin Prev Cardiol (2019);7:106-10.
- Frank Peacock, MD; Brigette M, et al. Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients with Possible Acute Coronary Syndrome. JAMA Cardiol(2018);3(2):104-111.
- Mats Holmberg , Henrik Andersson, et al. Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome. BMC Cardiovascular Disorders (2018) 18:216
- Xiaoteng Ma, Zhijian Wang, et al. Admission Heart Rate Is Associated With Coronary Artery Disease Severity and Complexity in Patients With Acute Coronary Syndrome. Angiology (2019) Vol. 70(8) 774-781
- Rajeev Gupta, Denis Xavier, et al. Hypertension: The most important non communicable disease risk factor in India. Indian Heart Journal (2018) 70;565–572.