UCONN Emergency Medicine Interest Group

Spotlight Lecture: Chest Pain Risk

In TALKS on June 20, 2011 at 10:53 PM

This is a brief review of a talk given by Dr. David Newman of the SMART EM podcast and thennt.com; it can be found here.

First, as background: the SMART EM podcast is a relatively new EM podcast that does “deep dives” into the EM literature, meaning that they actually look at the primary studies and evidence (or lack thereof) that guide the way that EM is practiced. It is a fantastic listen for anyone that is really interested in practicing evidence-based medicine, and often there are surprising finds that make you take pause.

This talk in particular is about evaluating the risk of chest pain in the ED, and specifically, the 2 patient-oriented outcomes that are important to us: MI, and death (generally within 30 days or 6 months). In brief, there were several important points that were discussed:

1. Framingham risk factors are not useful for predicting the risk of negative outcomes from chest pain except in patients younger than 40 and with >3 risk factors. Dr. Newman makes the point that the Framingham study and the risk factors derived thereof were developed to determine the risk for developing CAD, NOT acute MI.

2. Dr. Newman reviewed several well-done, large, prospective randomized studies that looked at the risk of bad outcome in several cohorts, from low risk chest pain under 40 years old (1:500), low risk chest pain over 40 years old (1:250), and moderate risk chest pain (1:125).

3. It is suggested that these risk statistics can be used to start a conversation with the patient about how to proceed and thus facilitate a shared decision making process.

References

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