• Luigi A Gabrielli, Pablo F Castro, Hugo E Verdejo, Paul A McNab, Silvana A Llevaneras, José M Mardonez, and Ramón L Corbalán.
• Departamento de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile.
• Rev Med Chil. 2008 Apr 1;136(4):442-50.

BackgroundNearly 10% of patients with an actual acute coronary syndrome (ACS) are discharged with an inadequate diagnosis.AimTo select clinical and laboratory predictors to identify patients with a high likelihood of ACS in the Chest Pain Unit.Material And MethodsProspective evaluation of patients consulting in a Chest Pain Unit of a University Hospital. Initial assessment was standardized and included evaluation of pain characteristics, electrocardiogram and Troponin I. Independent predictors of ACS were identified with a multiple logistic regression.ResultsIn a four years period, 1,168 patients aged 62+/-23 years (69% males), were studied. After initial evaluation, 62% of the patients were admitted to the hospital for further testing and in 71% of them, a definite diagnosis of ACS was made. No events were reported by patients directly discharged from the Chest Pain Unit. Independent predictors associated with a higher likelihood of ACS were an abnormal electrocardiogram at the initial evaluation (Odds ratio (OR) 5.37, 95% confidence intervals (CI) 3.61-7.99), two or more cardiovascular risk factors (OR 2.16, 95% CI 1.21-2.84), cervical irradiation of the pain (OR 1.84, 95% CI 1.25-2.69), age over 65 years (OR 1.73, 95% CI (1.32-2.27) and a Troponin I above the upper normal limit (OR: 5.68, 95% CI 3.72-8.29).ConclusionsSimple clinical findings allow an appropriate identification of patients with a high likelihood of ACS without specialized methods for myocardial ischemia detection.

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