PMID- 36942800
OWN - NLM
STAT- MEDLINE
DCOM- 20230725
LR  - 20231005
IS  - 1866-0452 (Electronic)
IS  - 1866-0452 (Linking)
VI  - 120
IP  - 18
DP  - 2023 May 5
TI  - Acute Chest Pain-Diagnostic Accuracy and Pre-Hospital Use of Anticoagulants and 
      Platelet Aggregation Inhibitors.
PG  - 317-323
LID - arztebl.m2023.0065 [pii]
LID - 10.3238/arztebl.m2023.0065 [doi]
AB  - BACKGROUND: Acute chest pain (aCP) can be a symptom of life-threatening diseases 
      such as acute coronary or aortic syndrome, but often has a non-cardiac cause. The 
      recommendations regarding pre-hospital drug treatment of patients with aCP are 
      ambiguous. METHODS: A retrospective cohort study was conducted of 822 patients 
      with aCP who were attended by emergency physicians. The cause of aCP was 
      classified as follows: acute coronary syndrome without ST-segment elevation 
      (NSTE-ACS), acute aortic syndrome, hypertensive crisis, cardiac arrhythmias, 
      musculoskeletal, or other. The suspected and discharge diagnoses were compared, 
      and the pre-hospital administration of acetylsalicylic acid (ASA) and 
      unfractionated heparin (UFH) was analyzed. Furthermore, the parameters that 
      improved diagnostic accuracy were investigated. RESULTS: The positive predictive 
      value of the diagnosis assigned by the emergency physician (EP diagnosis) was 
      39.7%. NSTEACS was the most commonly suspected cause of aCP (74.7%), but was 
      confirmed after hospital admission in only 26.3% of patients. ASA was 
      administered in 51%, UFH in 55%, and both substances in 46.4% of cases. A large 
      proportion of patients received anticoagulants in the pre-hospital setting 
      although the discharge diagnosis was not NSTE-ACS: ASA 62.9%, UFH 66.0%, both 
      substances 56.5%. CONCLUSION: ASA and UFH are often given to EP-accompanied 
      patients with aCP despite the low accuracy of diagnosis in the pre-hospital 
      setting. Pre-hospital measurement of high-sensitivity troponin T (hs Trop-T) 
      might improve discrimination between NSTE-ACS and other causes of aCP. This is 
      important, as the current guidelines contain no clear recommendations for 
      prehospital drug treatment in NSTE-ACS.
FAU - Braumann, Simon
AU  - Braumann S
AD  - Medical Faculty, University of Cologne, and Department of Internal Medicine III, 
      Cologne University Hospital; Department of Internal Medicine, Evangelical 
      Hospital Cologne-Weyertal; Medical Faculty, University of Cologne, and Institute 
      for Medical Statistics, Cologne University Hospital; Medical Faculty, University 
      of Cologne, and Clinical Acute and Emergency Medicine Team, Cologne University 
      Hospital; Medical Faculty, University of Cologne, and Department of Internal 
      Medicine II, Cologne University Hospital.
FAU - Faber-Zameitat, Christian
AU  - Faber-Zameitat C
FAU - Macherey-Meyer, Sascha
AU  - Macherey-Meyer S
FAU - Tichelbacker, Tobias
AU  - Tichelbacker T
FAU - Meertens, Max
AU  - Meertens M
FAU - Heyne, Sebastian
AU  - Heyne S
FAU - Niessen, Franz
AU  - Niessen F
FAU - Nies, Richard Julius
AU  - Nies RJ
FAU - Nettersheim, Felix
AU  - Nettersheim F
FAU - Reuter, Hannes
AU  - Reuter H
FAU - Pfister, Roman
AU  - Pfister R
FAU - Hellmich, Martin
AU  - Hellmich M
FAU - Burst, Volker
AU  - Burst V
FAU - Baldus, Stephan
AU  - Baldus S
FAU - Lee, Samuel
AU  - Lee S
FAU - Adler, Christoph
AU  - Adler C
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Dtsch Arztebl Int
JT  - Deutsches Arzteblatt international
JID - 101475967
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Humans
MH  - *Heparin/therapeutic use
MH  - Retrospective Studies
MH  - *Anticoagulants/therapeutic use
MH  - Aspirin/therapeutic use
MH  - Chest Pain/diagnosis/etiology
PMC - PMC10398374
EDAT- 2023/03/22 06:00
MHDA- 2023/07/25 06:42
PMCR- 2023/05/01
CRDT- 2023/03/21 07:32
PHST- 2022/09/20 00:00 [received]
PHST- 2022/09/20 00:00 [revised]
PHST- 2023/03/07 00:00 [accepted]
PHST- 2023/07/25 06:42 [medline]
PHST- 2023/03/22 06:00 [pubmed]
PHST- 2023/03/21 07:32 [entrez]
PHST- 2023/05/01 00:00 [pmc-release]
AID - arztebl.m2023.0065 [pii]
AID - 10.3238/arztebl.m2023.0065 [doi]
PST - ppublish
SO  - Dtsch Arztebl Int. 2023 May 5;120(18):317-323. doi: 10.3238/arztebl.m2023.0065.