P6501The CENTURY Study

Abstract

Background: Chest pain is one of the leading symptoms of presentation in the Emergency Department, representing up to 5% of ED accesses. Aim: Goal of this study is to describe the population of patients arriving in several Italian EDs complaining for chest pain suggestive of ACS, in order to evaluate the incidence of ACS in this ED population and the association between the presence of ACS and different clinical parameters and risk factors. Methods and results: The CENTURY (ChEst paiN iTalian Units emeRgencY) is an observational prospective study conducted in 10 different Emergency Departments in Italy from the 1st January to the 31st December 2014. Patients with chest pain suggestive of acute coronary syndrome, on the basis of clinical judgement, were enrolled consecutively. More than 95% of the database fields of the CRF had to be completed for the statistical analysis, using univariate and multivariate methods. Centers collected data on 7310 patients; the statistical analysis was conducted on 6340 patients with the final diagnosis of ACS (24.6%) and NO ACS (69,1%). Patients with ACS were older than NO ACS patients (70 years old vs 59 years old), with a prevalence of males in the two groups (66.1% in ACS vs 57.5% in NO ACS). Risk factors included in the database (family history of CVD, personal history of CHD, personal History of CVD, current smoker, hypercholesterolemia, BMI, hypertension, diabetes, chronic renal failure) showed a significant statistical association (univariate analysis) with the final diagnosis of ACS (p less than 0.001). Interestingly 59.1% of ACS patients had ECG alterations at admission (ECG within 10 minutes from the arrival at ED) compared with 5.8% of NO ACS patients. The percentage of ECG equal to a previous ECG was 13.4% for ACS vs 20.4% for NO ACS. To be underlined is the fact that 70.2% of NO ACS patients were discharged directly from ED after a few hours, and 21% within 36 hours. The multiple logistic regression analysis showed that six parameters were predictive for ACS: personal history of CHD (p less than 0.03), current smoke, hypertension, ECG alteration, BMI, spO2 (p less than 0.001). Concusions: The CENTURY is an observational study of patients with chest pain suggestive of ACS arriving to different EDs in Italy. While statistical analysis is influenced by less homogeneous data, this is the current situation in the Emergency Departments for chest pain patients.