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- Summary and Comment
Are Cardiac Risk Factors of Value in ED Diagnosis of ACS?
Not in patients older than 40
Population-based studies have shown that diabetes, hypertension, smoking, hypercholesterolemia, and family history of coronary vascular disease are correlated with an increased lifetime risk for cardiovascular disease. Clinicians often use cardiac risk factors in the assessment of patients with suspected acute coronary syndrome (ACS), but Bayesian theory dictates that the diagnostic value of the risk factors would not apply to individual patients. In a retrospective analysis of nearly 11,000 emergency department patients with suspected ACS, researchers evaluated the association between risk factor burden (number of factors) and ACS.
Patients were considered to have ACS if they underwent revascularization within 30 days, had a discharge diagnosis within one of the diagnostic-related groups for ACS, or had positive cardiac markers at admission and died within 30 days. Researchers divided patients into three groups based on age (<40, 40–65, and >65) and calculated positive and negative likelihood ratios by age group and by number of risk factors.
Overall, ACS was diagnosed in 8.1% of patients. In patients younger than 40, those with four or five risk factors were 22.5 times more likely to have ACS than those with no risk factors. In the other age groups, there was no significant positive correlation with risk factor burden.
Comment: The findings for patients older than 40 are consistent with those from other studies that have found the presence of cardiac risk factors to be of no discriminatory value in the emergent evaluation of patients with suspected ACS. In younger patients, though, the presence of four or five cardiac risk factors appears to greatly increase the likelihood of ACS. Certainly, in individual patients older than 40, cardiac risk factors should not be considered when determining whether ACS is, or is not, present.
— Richard D. Zane, MD, FAAEM
Published in Journal Watch Emergency Medicine March 9, 2007
Citation(s):
Han JH et al. The role of cardiac risk factor burden in diagnosing acute coronary syndromes in the emergency department setting. Ann Emerg Med 2007 Feb; 49:145-52.
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