The use of EKG to exclude a diagnosis of acute coronary syndrome in a population with low-risk chest pain

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Alexander Leung, Gaurav Puri, Vincent Ho and Steven Rhee


EKG, chest pain, low-risk, acute coronary syndrome


Background: Chest pain is a common chief complaint to emergency departments (ED) across Canada. These patients often have low-risk chest pain where incidence of acute coronary syndrome (ACS) is minimal. The development of a strategy to assess low-risk chest pain could improve and accelerate patient care.

Objective: To determine whether findings of a normal electrocardiogram (EKG) can rule out ACS in patients presenting with chest pain classified as low-risk in the ED

Methods: A retrospective chart review of patients presenting to the ED with low-risk chest pain, defined as patients between 16 and 40 years of age, was conducted in a medical center during a 1-year period from April 2011 to March 2012.

Results: Medical charts from a total of 1019 patients between the ages of 16 and 40 with a chief complaint of chest pain were identified. The EKG had sensitivity and specificity values of 71% and 65% respectively. The positive predictive value and negative predictive value were 14% and 97% respectively. Post-hoc subgroup analysis was performed to assess EKG findings and ACS in age groups 16-20, 21-30 and 31-40 years of age, and the sensitivities and specificities were calculated. For those 16-20 years of age, the sensitivity and specificity were 80% and 77%, respectively. For those 21-30 years of age, the sensitivity and specificity were 50% and 64%. For those 31-40 years of age, the sensitivity and specificity were 77% and 64%.

Conclusion: The use of EKG alone to exclude ACS is not recommended in patients presenting with low-risk chest pain.