Relationship between physiological parameters and acute coronary syndrome in patients presenting to the emergency department with undifferentiated chest pain

Abstract

Objective: The investigators of this study sought to examine whether abnormal physiological parameters are associated with increased risk for acute coronary syndrome (ACS) in patients presenting to the emergency department (ED) with chest pain. Methods: We used prospectively collected data on adult patients presenting with suspected ACS in 2 EDs in Australia and New Zealand. Trained research nurses collected physiological data including temperature, respiratory rate, heart rate, and systolic blood pressure (SBP) on presentation to the ED. The primary endpoint was ACS within 30 days of presentation, as adjudicated by cardiologists using standardized guidelines. The prognostic utility of physiological parameters for ACS was examined using risk ratios. Results: Acute coronary syndrome was diagnosed in 384 of the 1951 patients (20%) recruited. Compared with patients whose SBP was between 100 and 140 mm Hg, patients with an SBP of lower than 100 mm Hg or higher than 140mmHgwere 1.4 times (95%confidence interval, 1.2Y1.7)more likely to have ACS. Similarly, compared with patients whose temperature was between 36.5-C and 37.5-C, patients with temperature of lower than 36.5-C or higher than 37.5-C were 1.4 times (95%confidence interval, 1.1Y1.6) more likely to have ACS. Heart rate and respiratory rate were not predictors of ACS. Conclusions: Patients with abnormal temperature or SBP were slightly more likely to have ACS, but such risk was of too small a magnitude to be useful in clinical decision making. Other physiological parameters (heart rate and respiratory rate) had no prognostic value. The use of physiological parameters cannot reliably confirm or rule out ACS.