Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre

Paul-Georges Reuter, Catherine Pradeau, Samantha Huo Yung Kai, Thibault Lhermusier, Arnaud Bourdé, Eric Tentillier, Xavier Combes, Vanina Bongard, Jean-Louis Ducassé, Sandrine Charpentier, Paul-Georges Reuter, Catherine Pradeau, Samantha Huo Yung Kai, Thibault Lhermusier, Arnaud Bourdé, Eric Tentillier, Xavier Combes, Vanina Bongard, Jean-Louis Ducassé, Sandrine Charpentier

Abstract

Background: Chest pain is a frequent reason for calls in emergency medical communication centre (EMCC). Detecting a coronary origin by phone is a challenge. This is especially so as the presentations differ according to gender. We aimed to establish and validate a sex-based model to predict a coronary origin of chest pain in patients calling an EMCC.

Methods: This prospective cohort study enrolled patients at 18 years of age or older who called the EMCC because of non-traumatic chest pain. The main outcome was the diagnosis of acute coronary syndrome (ACS) determined by expert evaluation of patient files.

Results: During 18 months, 3727 patients were enrolled: 2097 (56%) men and 1630 (44%) women. ACS was diagnosed in 508 (24%) men and 139 (9%) women. For men, independent factors associated with an ACS diagnosis were age, tobacco use, severe and permanent pain; retrosternal, breathing non-related and radiating pain; and additional symptoms. The area under the receiver operating characteristic curve (AUC) was 0.76 (95% confidence interval [CI] 0.73-0.79) for predicting ACS. The accuracy of the male model to predict ACS was validated in a validation dataset (Hosmer-Lemeshow test: p = 0.554); the AUC was 0.77 (95%CI 0.73-0.80). For women, independent factors associated with an ACS diagnosis were age ≥ 60 years, personal history of coronary artery disease, and breathing non-related and radiating pain. The AUC was 0.79 (95%CI 0.75-0.83). The accuracy of the female model to predict ACS was not validated in the validation dataset (Hosmer-Lemeshow test: p = 0.035); the AUC was 0.67 (95%CI 0.60-0.74).

Conclusions: Predictors of an ACS diagnosis in patients calling an EMCC for chest pain differ between men and women. We developed an accurate predictive model for men, but for women, the accuracy was poor.

Trial registration: This study is registered with ClinicalTrials.gov ( NCT02042209 ).

Keywords: Accuracy; Acute coronary syndrome; Chest pain; Emergency medical communication Centre; Sex disparity.

Conflict of interest statement

All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Flowchart based on final diagnosis for men (a) and women (b). ACS: Acute Coronary Syndrome; NSTEMI: Non ST Elevation Myocardial Infarction; STEMI: ST Elevation Myocardial Infarction
Fig. 2
Fig. 2
Proportions of acute coronary syndrome cases observed and predicted for males (a) and females (b)

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