Characteristics of acute coronary syndrome = acute myocardial infarction + unstable angina included studies.
| Study | Design | Sample size | % ACS | Mean age | % Males | Setting | Inclusion | Exclusion | Reference Standard |
|---|---|---|---|---|---|---|---|---|---|
| Lee, et al, 198523 | Prospective consecutive | 596 | 41 | 56 | 48 | ED | Chief complaint of anterior, precordial or left lateral chest pain | Local trauma, abnormalities on chest X-ray, <25 yr | AMI: one of characteristic evolution of enzyme levels (CK-MB, LDH, CK), Q-waves, scintiscan. UA: chest pain worse or new and diagnosis was made by a senior clinician |
| Hargarten, et al, 198725 | Retrospective consecutive | 401 | 57 | 65 | ? | Para | ‘Stable’ chest pain | Heart failure, rhythm problems, hypotension | AMI: ST-elevation followed by T-inversion (at least two leads), CPK-MB, LDH ration, autopsy pyrophosphate scan UA: no |
| Grijseels, et al, 199532 | Prospective consecutive | 1005 | 42 | 67 | 54 | GP | Symptoms of possible cardiac origin seen by GP and transferred | No | AMI: standard history, ECG, enzyme criteria UA: angina with increasing frequency and severity and new recent onset with documentation of ST-T changes at rest, abnormal stress test or coronary arteriogram |
| Pope, et al, 199836 | Prospective consecutive | 10689 | 23 | 59 | 52 | ED | Chief complaint of chest, left arm, jaw or epigastric pain or discomfort, dyspnoea, dizziness, palpitations or other symptoms suggestive of acute ischemia | <30 yr, 18 yr if suspected to have used cocaine | AMI: WHO criteria for AMI UA: Canadian Cardiovascular Society classification criteria |
| Milner, et al, 200138 | Prospective consecutive | 531 | 40 | 60 | 53 | ED | >45 yr and one symptom suggestive of ACS, or 18–44 yr if diabetes and two risk factors | <45 yr without diabetes or <18 yr with diabetes | AMI: elevated cardiac enzymes (CK-MB). UA: ECG changes (ST, T) and no cardiac enzymes elevation |
| Herlitz, et al, 200239 | Retrospective consecutive | 930 | 30 | 71 | 51 | Para | Chest pain or slightest suspicion of an acute coronary syndrome | No | AMI: two of chest pain>15 min, CK more than twice upper limit, Q-wave A: according to clinical judgement |
| Goodacre, et al, 200240 | Prospective consecutive | 893 | 9 | 53 | 62 | CPOU | Chest pain (patients at low risk) | <25 yr, trauma, new ECG changes consistent with ischemia, comorbidity necessitating hospitalisation, definite unstable angina | AMI: WHO criteria for AMI. ACS: present or in following 6 months: AMI, cardiac death, arrhythmia or revascularisation |
| Vodopiutz, et al, 200243 | Prospective at random | 92 | 47 | 62 | 48 | CCU | Admitted because of chest pain as main symptom | Refused, too sick, language problems | AMI: angio, autopsy, scintigraphy, echocardio, ECG and enzyme kinetics UA: no |
| Svensson, et al, 200344 | Prospective consecutive | 538 | 57 | 69 | 58 | Para | Due to chest pain or discomfort >15 min, within last 6 hr, dyspnoea, or any condition suggesting acute CS | Lung disease | AMI: two of: typical symptoms, Q-waves, CK-MB >10 ng/ml or troponin >0.05 ng/ml Myocardial ischemia: dynamic changes ECG, no increase biochemical markers |
| Goodacre, et al, 200345 | Prospective consecutive | 972 | 8 | 50 | 64 | ED | ‘Undifferentiated chest pain’ all patients attending with chest pain or related complaint (low risk) | Evidence of ACS (ECG or clear clinical) requiring admission, clear non-cardiac cause no informed consent | ACS: any elevation of T (after 2 days) or after 30 days: cardiac death, non-fatal myocardial infarction, new-onset heart failure, life-threatening arrhythmia or coronary revascularisation procedure |
| Christenson, et al, 200646 | Prospective 7am–10pm | 769 | 21 | 58 | 62 | ED | Primary complaint of anterior or lateral chest pain | <25 yr, traumatic or XR-evident cause, enrolled in study 30 days previously, communication problems, no fixed address in British Columbia, without available telephone contact | AMI: one of 1) CK-MB increase definite for AMI (specific hospital criteria) or troponin I >1.0 μg/l 2) troponin I increase (<1.0) and ECG changes (ischemia), coronary angiogram >70% lesion, positive stress test or urgent revascularisation 3) ECG evolution consistent AMI 4) fibrinolytic therapy or angioplasty with clinical diagnosis of AMI 5) death with no other definite cause. UA: chest pain of 20 min at least and one of: 1) troponin I increase to 0.99 maximum and no other AMI criteria 2) dynamic ECG changes (ischemia) (ST or T), but not persistent ST elevation 3) coronary angiogram (70% lesions) and hospital admission 4) positive stress test and hospital admission |
Car = cardiologist; CCU = coronary care unit or admitted to hospital, CPOU = chest pain observation unit, ECD = electrocardiogram, ED = emergency department, Para = paramedics of an ambulance. ACS = acute coronary syndrome. AMI = acute myocardial infarction. CK = creatine kinase. CK-MB = CK isoenzyme. CS = coronary syndrome. ECG = echocardiogram. LDH = lactate dehydrogenase. UA = unstable angina. WHO = World Health Organization. XR = X-rays.