Document Type : Original Article

Authors

1 Department of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Emergency Medicine, Loghmane Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI) in Emergency Department (ED) patients with non-diagnostic ECG changes.

Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, Hypertension (HTN), Hyperlipidemia (HLP), renal failure, positive family history of Coronary Artery Disease (CAD), smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH), etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB) serum markers and Troponin I. The data were analyzed by using SPSS V. 20 and the level of statistical significance was considered to be P< 0.05.

Results: HTN, HLP, family history of heart disease were significantly higher in those who had non-diagnostic ECG (P< 0.05). However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG.

Conclusion: Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI) in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.

Keywords

Main Subjects

1. Nickerson CJ, Haudenschild CC, Chobanian AV. Effects of hypertension and hyperlipidemia on the myocardium and coronary vasculature of the WHHL rabbit. Exp Mol Pathol 1992; 56 (3): 173-85.
2. Assmann G, Schulte H. Diabetes mellitus and hypertension in the elderly: concomitant
hyperlipidemia and coronary heart disease risk. Am J Cardiol 1989; 63 (16): 33-7.
3. Gibler WB, Lewis LM, Erb RE, Makens PK, Kaplan BC, Vaughn RH, et al. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg Med 1990; 19 (12): 1359-66.
4. Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E, et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009; 361 (9): 868-77.
5. Kashani P. Investigation, the association of cardiac risk factors and the risk of acute myocardial infarction, in ED patients with non-diagnostic ECG. Prehospital and Disaster Medicine 2011; 26: s165.
6. Conti, DelRe C, Cagliarelli G, Falcini F, Daviddi F, Grifoni S, et al. C012: Hypertension and myocardial ischemia in patients presenting at the E.R. with chest pain and non-diagnostic ECG. Am J Hypertens 2000; 13: 72A.
7. Sanchis J, Bodí V, Núñez J, Bertomeu-González V, Gómez C, Bosch MJ, et al. New risk score for patients with acute chest pain, non-st-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score. J Am Coll Cardiol 2005; 46: 443-9.
8. Conti A, Poggioni C, Viviani G, Luzzi M, Vicidomini S, Zanobetti M, et al. Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram. Am J Emerg Med 2012; 30 (9):
1698-705.
9. Erhardt L, Herlitz J, Bossaert L, Halinen M, Keltai M, Koster R, et al. Task force on the management of chest pain. Eur Heart J 2002; 23 (15): 1153-76.
10. Lee TH, Goldman L. Evaluation of the patient with acute chest pain. N Engl J Med 2000; 342 (16): 1187-95.
11. Goodacre S1, Cross E, Lewis C, Nicholl J, Capewell S. Effectiveness and safety of chest pain assessment to prevent emergency admissions: ESCAPE cluster randomised trial. BMJ 2007; 335: 659.
12. Pollack CV Jr, Sites FD, Shofer FS, Sease KL, Hollander JE. Application of the TIMI risk score for unstable angina and non‐ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med 2006; 13 (1): 13-8.
13. Tong KL, Kaul S, Wang XQ, Rinkevich D, Kalvaitis S, Belcik T,et al. Myocardial contrast echocardiography versus thrombolysis in myocardial infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram. J Am Coll Cardiol 2005; 46 (5): 920-7.
14. Chase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE. Prospective validation of the thrombolysis in myocardial infarction risk score in the emergency department chest pain population. Ann Emerg Med 2006; 48 (3): 252-9.