Predictors of acute coronary syndrome in pre hospital patients with chest pain.

BACKGROUND: Non-traumatic chest pain is a common cause in pre hospital emergency medicine. The objective of our study was to identify predictive factors of STEMI in patients with acute chest pain, on telephone interview. METHODS: We conducted a prospective observational study over a period of one year (december 2017 to november 2018) in the Emergency Care System of the North Est (SAMU 01) of Tunisia. We included all adults patients aged more than 18 years old, calling the emergency dispatch center for acute non traumatic chest pain (CP). The demographic and clinical data were collected and studied to identify the predictive factors for STEMI. RESULTS: We included 368 patients. The average age was 56 ± 15 years, the sex ratio was 2.7. Smoking was the most common cardiovascular risk factor (41%) followed by hypertension (31%) and coronary artery disease (20%). Half of calls were made by doctors and 43% of them were made within the first two hours of onset of the CP. Clinical examination showed cardio respiratory arrest in 10 patients, 6 of them were related to STEMI. On the arrival of our emergency mobile teams, an elevation of ST segment was identified in 118 patients (32%) of which 37% were admitted directly into the catheterization room. In multivariate analysis, the independent predictive factors of STEMI were: diabetes (OR = 5.25; CI [1.61 - 17.06]), smoking (OR = 2.78, CI [1.03 - 7.5]), typical CP (OR = 4.68, CI [1.09 - 21.67]), CP persistence of more than 30 min (OR = 63.31, CI [13.51 - 29.49]). CONCLUSION: History of diabetes, smoking, typical and persistent CP were the main factors associated with STEMI in patients calling the emergency dispatch center for an acute CP. The early identification of these factors by the emergency physician will improve the management of acute CP since the medical regulation.