• Simon Braumann, Christian Faber-Zameitat, Sascha Macherey-Meyer, Tobias Tichelbäcker, Max Meertens, Sebastian Heyne, Franz Nießen, Richard Julius Nies, Felix Nettersheim, Hannes Reuter, Roman Pfister, Martin Hellmich, Volker Burst, Stephan Baldus, Samuel Lee, and Christoph Adler.
• Medical Faculty, University of Cologne, and Department of Internal Medicine III, Cologne University Hospital; Department of Internal Medicine, Evangelical Hospital Cologne-Weyertal; Medical Faculty, University of Cologne, and Institute for Medical Statistics, Cologne University Hospital; Medical Faculty, University of Cologne, and Clinical Acute and Emergency Medicine Team, Cologne University Hospital; Medical Faculty, University of Cologne, and Department of Internal Medicine II, Cologne University Hospital.
• Dtsch Arztebl Int. 2023 May 5; 120 (18): 317323317-323.

BackgroundAcute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome, but often has a non-cardiac cause. The recommendations regarding pre-hospital drug treatment of patients with aCP are ambiguous.MethodsA retrospective cohort study was conducted of 822 patients with aCP who were attended by emergency physicians. The cause of aCP was classified as follows: acute coronary syndrome without ST-segment elevation (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmias, musculoskeletal, or other. The suspected and discharge diagnoses were compared, and the pre-hospital administration of acetylsalicylic acid (ASA) and unfractionated heparin (UFH) was analyzed. Furthermore, the parameters that improved diagnostic accuracy were investigated.ResultsThe positive predictive value of the diagnosis assigned by the emergency physician (EP diagnosis) was 39.7%. NSTEACS was the most commonly suspected cause of aCP (74.7%), but was confirmed after hospital admission in only 26.3% of patients. ASA was administered in 51%, UFH in 55%, and both substances in 46.4% of cases. A large proportion of patients received anticoagulants in the pre-hospital setting although the discharge diagnosis was not NSTE-ACS: ASA 62.9%, UFH 66.0%, both substances 56.5%.ConclusionASA and UFH are often given to EP-accompanied patients with aCP despite the low accuracy of diagnosis in the pre-hospital setting. Pre-hospital measurement of high-sensitivity troponin T (hs Trop-T) might improve discrimination between NSTE-ACS and other causes of aCP. This is important, as the current guidelines contain no clear recommendations for prehospital drug treatment in NSTE-ACS.

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