The study is chosen to help understand the current state of knowledge regarding the clinical profile of low risk Acute Coronary Syndrome (ACS) and to generate data for future recommendations. 100 patients presenting to the Emergency Department (ED) with acute onset chest pain with normal electrocardiogram (ECG) and negative cardiac biomarkers and with alternative diagnosis less likely were enrolled for a prospective observation and evaluation. All the patients underwent periodic biomarkers and serial ECGs. Endpoint of the study was either the diagnosis of ACS or a cardiologist examination confirming a low risk ACS. Out of 100 patients 4 patients subsequently were diagnosed with ACS and managed accordingly. Factors such as age < 40 years (sensitivity 100% with CI 94.48%-100%, specificity 11.43%, PPV 67.71%, NPV 100%, accuracy 69%), female sex (sensitivity 66.67% with CI 56.31%-75.96%, specificity 25%, PPV 95.52%, NPV 3%, accuracy 65%), sharp nature of pain (sensitivity 9.38% with CI 4.38%-17.05%, specificity 100%, PPV 100%, NPV 4.4%, accuracy 13%) and pain defined as slightly suspicious by the examining physician (sensitivity 91.67% with CI 84.24%-96.33%, specificity 100%, PPV 100%, NPV 33.33%, accuracy 13%) were associated with high likelihood of low risk ACS. Pulse, respiration and saturation of all the patients were well maintained. Although heart rate has been positively correlated with ACS in previous studies our study showed that it has little correlation in low risk ACS cases. Only variable which had variance was systolic blood pressure with a standard deviation of 16. The mean systolic blood pressure was 127.62 mm of Hg.

Keywords: low risk, low probability acute coronary syndrome, clinical profile.

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Zahid Shaikh

Department of Emergency Medicine, Dr. D. Y. Patil Medical College and Research Center, Dr. D. Y. Patil Vidhyapeeth, Sant Tukaram Nagar, Pimpri, Pune – 18