Nonspecific electrocardiographic abnormalities are associated with increased length of stay and adverse cardiac outcomes in prehospital chest pain.
Diana Rivero, Mohammad Alhamaydeh, Ziad Faramand and 5 others
PMID 30309629WHAT IT FOUND
Nonspecific ECG ST changes occurred in 17.5% of 750 chest pain patients and were associated with 9.9% versus 4.4% 30-day major cardiac events and 1-day longer stays, so ST telemetry alarms may be unreliable.
Key findings
01Nonspecific ST changes were present on the prehospital ECG in 131 patients (17.5%).
02The primary outcome of 30-day major adverse cardiac events occurred in 9.9% of patients with nonspecific ST changes versus 4.4% of those without (p=0.011).
03Patients with nonspecific ST changes had an average 1-day longer hospital stay (2.0 versus 1.0 days, p=0.012), and this remained significant after accounting for chest pain cause.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational cohort, so it shows association, not that nonspecific ST changes caused longer stays or adverse cardiac events. The sample was relatively small and the event rate was low, and the authors said the study may have been underpowered for some predictors. Patients were transported by Emergency Medical Services and may be higher acuity than all ED patients with chest pain. No time-to-event data were available, so the analysis could not examine when events occurred. The study did not test alternative monitoring or preventive management; those recommendations come from the Discussion.
Declared interests
No conflicts of interest were declared. The article is tagged as supported by NIH extramural research, but the text does not state a specific funder role.
The easy way to misread this
Do not read nonspecific ST changes as evidence of acute coronary syndrome: ACS rates were 18% versus 15% and not significant; the association was with 30-day major adverse cardiac events and longer stay.