• Tony Zitek, Elizabeth Chen, Armando Gonzalez-Ibarra, and Jessica Wire.
• Kendall Regional Medical Center, Miami, FL, United States; Nova Southeastern University, Kiran C. Patel College of Allopathic Medicine, United States; University Medical Center of Southern Nevada, Las Vegas, Nevada, United States. Electronic address: Zitek10@gmail.com.
• Am J Emerg Med. 2020 Jul 1; 38 (7): 1377-1383.

ObjectiveWe sought to determine if the duration of pain or other features of the history predict major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED).MethodsThis was a prospective cohort study of patients presenting to a single ED with chest pain. Consenting patients filled out a survey about their symptoms. After 6 weeks, we assessed patients for MACE via chart review and direct contact. We used this data to calculate the likelihood ratios (LRs) of a number of historical features for acute myocardial infarction (MI) (primary endpoint) and MACE within 6 weeks (secondary endpoint). We planned a priori to analyze patients who reported chest pain for ≤1 min or continuously for ≥24 h.ResultsWe enrolled 1002 patients, and 83.6% had successful 6-week follow up. Regarding chest pain lasting for ≤1 min, the positive LR was 0.95 (95% CI 0.24 to 3.80) for acute MI and 0.67 (95% CI 0.17 to 2.72) for MACE within 6 weeks. The positive LRs of continuous pain lasting ≥24 h for acute MI and MACE within 6 weeks were 0.15 (95% CI 0.04 to 0.58) and 0.36 (95% CI 0.18 to 0.74), respectively. Amongst other historical features assessed, radiation to the right arm was the strongest positive predictor of acute MI.ConclusionPatients with continuous chest pain for ≥24 h are unlikely to have an acute MI. Chest pain lasting ≤1 min does not exclude acute MI.Copyright © 2019 Elsevier Inc. All rights reserved.

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