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The Relationship Between Chest Pain Duration and the Incidence of Acute Myocardial Infarction Among Patients With Acute Chest Pain

Assaad, Mahmoud C. MD*; Calle-Muller, Carlos MD*; Dahu, Musa MD; Nowak, Richard M. MD; Hudson, Michael P. MD§; Mueller, Christian MD; Jacobsen, Gordon MS; McCord, James MD§

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine:
doi: 10.1097/HPC.0b013e31829274ff
Original Article
Abstract

Objective: Eight to ten million individuals are evaluated for chest pain (CP) in Emergency Departments (ED) in the United States each year. CP characteristics are an important factor used to help determine a diagnosis. We studied the relationship between the duration of CP and the diagnosis of acute myocardial infarction (AMI) in patients evaluated in the ED.

Methods: The study population consisted of a sub-group analysis of a previously published study. The survey population consisted of 1024 consecutive encounters of patients who were evaluated for possible ACS in the ED of Henry Ford Hospital between January and May of 1999, CP duration could be obtained in 426 who were included in this analysis.

Results: Of the 426 patients included in the study, 38 (8.9%) had a final diagnosis of AMI, with a median CP duration of 120 minutes (interquartile range, 30-240 minutes), compared with 40 minutes (interquartile range, 6-180 minutes) in patients without AMI (p =0.003). In patients with CP duration less than 5 minutes, there were no AMIs and no deaths at 30 days. There were 10 patients dead at 30 days, with a median CP duration of 180 minutes (interquartile range, 120-1440 minutes) compared to 40 minutes (interquartile range, 10-180 minutes) in patients alive at 30 days (p = 0.011). A longer CP duration and ST depression of 1 mm of less were independently associated with a final diagnosis of AMI.

Conclusion: Patients with AMI have longer duration of CP than those without AMI; patients with CP of short duration, less than 5 minutes, are unlikely to have AMI and have a good prognosis at 30 days.

Author Information

From the *Department of Internal Medicine, Henry Ford Hospital, Detroit, MI; Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI; Department of Emergency Medicine, Henry Ford Health System, Detroit, MI; §Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI; Cardiology, University Hospital Basel, Basel, Switzerland; and Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI.

Drs. Assaad and Calle-Muller contributed equally to this article.Reprints: Carlos Calle-Muller, MD, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI. E-mail: ccalle1@hfhs.org.

© 2013 by Lippincott Williams & Wilkins