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Initial ECG as a Diagnostic Tool for Identification of Low Risk Patients with Chest Pain

Naveena S Brid, Raju UR, and Pooja Kamat

Large number of admissions to Intensive Coronary Care Unit (ICCU) for chest pain evaluation not only drains resources, but cause congestion and adds to the burden on hospital staff. The decision whether to admit or not to admit a patient to hospital requires accurate assessment of patients at ICCU. To study value of initial ECG to identify patient with low risk for developing AMI, thus avoiding unnecessary admissions. In this prospective cross-sectional study,patients admitted to ICCU were included and their initial electrocardiogram (ECG)wasrecorded after taking a detailed history and classified into four categories as Category1 (normal ECG, no ischemia or infarction), Category II (abnormal ECG with vague suspicion of AMI), Category III (abnormal ECG with strong suspicion of AMI), and Category IV (abnormal ECG with AMI). Serial ECGs were taken for all patients for 48 hours. Category I: 132 patients in this category, Only one patient (0.80%) evolved to AMI as Category IV. Category II: 18 patients were included. 3 patients (22.20%) evolved to AMI after 24 hours.Category III: 30 patients were admittedin this group, of whom, 20 (66.70 %) had AMI on second day of admission. Category IV: 246 patients included in this group had AMI. The present study showed that there is a safety margin between low risk and high risk group for AMI. Patients with initial normal ECG may be admitted in step down care to avoid ICCU congestion and for better care for those in need.