Abstract 22: Acute Coronary Syndrome--Related Symptoms on the Scene and Actual Diagnoses

Introduction Little is known about the association between acute coronary syndrome (ACS)-related symptoms and actual diagnoses. Objective To compare the occurrence of ACS between those with ACS-related symptoms and those without. Method Design: Population-based cohort study. Participants: All persons aged 20 years or more who called an ambulance because of internal diseases and who were taken to a hospital by emergency medical service (EMS) personnel in Osaka, Japan in January, 2011. Data collection and analyses: Data on patients' symptoms including chest pain and other ACS-related symptoms; shortness of breath, syncope, cold sweat, vomiting, and palpitation were prospectively collected on the scene by an EMS interview. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either chest pain or chest pain plus other ACS-related symptoms for the occurrence of ACS were calculated. Results Among 8876 cases, 207 (2.3%) was diagnosed as ACS. 424 (4.8%) had chest pain and 205 (2.3%) had both chest pain and other ACS-related symptoms. The sensitivity, specificity, PPV, and NPV of chest pain for ACS were 32.9% (68/207), 95.8% (8092/8448), 16.0% (68/424), and 98.3% (8092/8231), respectively (Table A). The sensitivity, specificity, PPV, and NPV of chest pain plus other ACS-related symptoms for ACS were 17.9% (37/207), 98.0% (8280/8448), 18.0% (37/205), and 98.0% (8280/8450), respectively (Table B). Conclusion The specificity and NPV of chest pain for ACS were very high. However, the PPV of ACS-related symptoms was poor even if the patient had both chest pain and other ACS-related symptoms. Further research is needed to detect additional factors to increase the diagnostic accuracy of ACS. ![Graphic][1] [1]: /embed/inline-graphic-1.gif