ORIGINAL ARTICLE   

Minerva Medica 2020 April;111(2):120-32

DOI: 10.23736/S0026-4806.20.06472-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

An Italian registry of chest pain patients in the emergency department: clinical predictors of acute coronary syndrome

Paola BALLARINO ¹, Gianfranco CERVELLIN ², Cecilia TRUCCHI ³, Fiorella ALTOMONTE ¹, Alessio BERTINI ⁴, Laura BONFANTI ², Maria A. BRESSAN ⁵, Giuseppe CARPINTERI ⁶, Paola NOTO ⁶, Francesco GAVELLI ^{7, 8}, Luca MOLINARI ^{7, 8}, Filippo PATRUCCO ^{7, 8}, Pier Paolo SAINAGHI ^{7, 8}, Silvia CARISTIA ^{7, 8}, Mario CAVAZZA ⁹, Mauro GALLITELLI ¹⁰, Stefania LONGO ¹¹, Paolo CREMONESI ¹², Andrea ORSI ³, Filippo ANSALDI ³, Rossella MARINO ¹³, Salvatore DI SOMMA ¹³, Luigi M. CASTELLO ^{7, 8} ✉, Paolo MOSCATELLI ¹, Gian Carlo AVANZI ^{7, 8} on behalf of Great Network Italy

¹ Emergency Department, San Martino University Hospital, Genoa, Italy; ² Emergency Department, Parma University Hospital, Parma, Italy; ³ Department of Health Science, University of Genoa, Genoa, Italy; ⁴ Emergency Department, Pisa University Hospital, Pisa, Italy; ⁵ Emergency Department, San Matteo University Hospital, Pavia, Italy; ⁶ Emergency Department, Vittorio Emanuele University Hospital, Catania, Italy; ⁷ Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; ⁸ Emergency Department, Maggiore della Carità University Hospital, Novara, Italy; ⁹ Emergency Department, S. Orsola-Malpighi University Hospital, Bologna, Italy; ¹⁰ Emergency Department, SS Giovanni e Paolo Hospital, Venice, Italy; ¹¹ Internal Medicine and Emergency Department, Bari University Hospital, Bari, Italy; ¹² Emergency Department, Galliera Hospital, Genoa, Italy; ¹³ Department of Medical-Surgery Sciences and Translational Medicine, Sapienza University, Rome, Italy

BACKGROUND: The aim of this study was to describe the population of patients arriving in several Italian Emergency Departments (EDs) complaining of chest pain suggestive of acute coronary syndrome (ACS) in order to evaluate the incidence of ACS in this cohort and the association between ACS and different clinical parameters and risk factors.
METHODS: This is an observational prospective study, conducted from the 1st January to the 31st December 2014 in 11 EDs in Italy. Patients presenting to ED with chest pain, suggestive of ACS, were consecutively enrolled.
RESULTS: Patients with a diagnosis of ACS (N.=1800) resulted to be statistically significant older than those without ACS (NO ACS; N.=4630) (median age: 70 vs. 59, P<0.001), and with a higher prevalence of males (66.1% in ACS vs. 57.5% in NO ACS, P<0.001). ECG evaluation, obtained at ED admission, showed new onset alterations in 6.2% of NO ACS and 67.4% of ACS patients. Multiple logistic regression analysis showed that the following parameters were predictive for ACS: age, gender, to be on therapy for cardio-vascular disease (CVD), current smoke, hypertension, hypercholesterolemia, heart rate, ECG alterations, increased BMI, reduced SaO2.
CONCLUSIONS: Results from this observational study strengthen the importance of the role of the EDs in ruling in and out chest pain patients for the diagnosis of ACS. The analysis put in light important clinical and risk factors that, if promptly recognized, can help Emergency Physicians to identify patients who are more likely to be suffering from ACS.

KEY WORDS: Chest pain; Hospital emergency service; Risk factors; Acute coronary syndrome; Myocardial infarction