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Medline ® Abstract for Reference 25

of 'Evaluation of the adult with chest pain in the emergency department'

Outcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings.
Slater DK, Hlatky MA, Mark DB, Harrell FE Jr, Pryor DB, Califf RM
Am J Cardiol. 1987;60(10):766.
Seven hundred seventy-five consecutive patients with symptoms suggestive of acute myocardial infarction (AMI) who were admitted to the cardiac care unit from the emergency room were studied; 107 had normal electrocardiographic findings and 73 had only minimal nonspecific changes. AMI subsequently evolved in 11 patients (10%) with normal electrocardiographic findings and in 6 (8%) with minimal changes, compared with 245 (41%) with frankly abnormal emergency room findings. Only 1 (1%; 95% confidence limits 0.02 to 5%) and 4 (6%; 95% confidence limits 2 to 15%) of those with normal and nonspecific initial electrocardiographic findings, respectively, had a complication for which they potentially benefited from intensive care unit intervention, although many patients received prophylactic therapy. Thus, the initial emergency room electrocardiogram can effectively separate patients into high- and low-risk groups for AMI and serious complications. Admission to a monitored intermediate care ward may be an acceptable practice in patients with chest pain and a normal or minimally changed initial electrocardiogram.
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.