Influence of previous coronary artery bypass grafting in the difficulty of acute coronary syndrome diagnosis.
Journal
European journal of emergency medicine : official journal of the European Society for Emergency Medicine
ISSN: 1473-5695
Titre abrégé: Eur J Emerg Med
Pays: England
ID NLM: 9442482
Informations de publication
Date de publication:
01 Apr 2021
01 Apr 2021
Historique:
pubmed:
26
9
2020
medline:
25
6
2021
entrez:
25
9
2020
Statut:
ppublish
Résumé
To investigate whether the diagnosis of acute coronary syndrome (ACS) in coronary artery bypass grafting (CABG) patients with chest pain (CP) is more difficult based on the initial clinical and electrocardiogram (ECG) findings. We included consecutive CP patients attended at a single emergency department (ED) during a 10-year period. CABG status and the final diagnosis of ACS were considered as stated in the ED discharge report. We evaluated the frequency of 21 CP characteristics (CPC) and four ECG signatures, their individual and collective association with ACS, and ED length of stay (LOS) in CABG and non-CABG patients. We included 34 429 patients [median age: 61 years; female: 41.8%; CABG: 2204 patients (6.4%)], and ACS was diagnosed in 6727 (19.5%; CABG/non-CABG 37.2%/18.3%; P < 0.001). CABG patients more frequently had CPC and ECG findings typically associated with ACS, but their final association with ACS was weaker than in non-CABG patients (only significant after adjustment for attendant diaphoresis, throat irradiation, ST-segment elevation and T-wave inversion). The collective discriminative capacity was significantly lower in CABG patients (area under the curve 0.710 vs. 0.793; P < 0.001), even after adjustment (0.708 vs. 0.790; P < 0.001). ED LOS was longer for CABG patients, overall (P < 0.001) and for patients diagnosed with ACS (P = 0.008) and non-ACS (P < 0.001), but these differences disappeared after adjustment. CABG substantially reduces the diagnostic performance of CPC and ECG findings to suggest ACS. A longer LOS in the ED in CABG patients is more related to their baseline characteristics than to CABG itself.
Identifiants
pubmed: 32976310
pii: 00063110-202104000-00011
doi: 10.1097/MEJ.0000000000000755
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
125-135Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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