RT Journal Article
SR Electronic
T1 Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e1
OP e8
DO 10.3399/bjgp08X277014
VO 58
IS 547
A1 Bruyninckx, Rudi
A1 Aertgeerts, Bert
A1 Bruyninckx, Pieter
A1 Buntinx, Frank
YR 2008
UL http://bjgp.org/content/58/547/e1.abstract
AB Background Prompt diagnosis of acute myocardial infarction or acute coronary syndrome is very important.Aim A systematic review was conducted to determine the accuracy of 10 important signs and symptoms in selected and non-selected patients.Design of study Diagnostic meta-analysis.Method Using MEDLINE, CINAHL, EMBASE, tracing references, and by contacting experts, studies were sought out that described one of the 10 signs and symptoms on one or both conditions. Studies were excluded if they were not based on original data. Validity was assessed using QUADAS and all data were pooled using a random effects model.Results Sixteen of the 28 included studies were about patients who were non-selected. In this group, absence of chest-wall tenderness on palpation had a pooled sensitivity of 92% (95% confidence interval [CI] = 86 to 96) for acute myocardial infarction and 94% (95% CI = 91 to 96) for acute coronary syndrome. Oppressive pain followed with a pooled sensitivity of 60% (95% CI = 55 to 66) for acute myocardial infarction. Sweating had the highest pooled positive likelihood ratio (LR+), namely 2.92 (95% CI = 1.97 to 4.23) for acute myocardial infarction. The other pooled LR+ fluctuated between 1.05 and 1.49. Negative LRs (LR−) varied between 0.98 and 0.23. Absence of chest-wall tenderness on palpation had a LR− of 0.23 (95% CI = 0.18 to 0.29).Conclusions Based on this meta-analysis it was not possible to define an important role for signs and symptoms in the diagnosis of acute myocardial infarction or acute coronary syndrome. Only chest-wall tenderness on palpation largely ruled out acute myocardial infarction or acute coronary syndrome in low-prevalence settings.