Relationship between acute coronary syndrome and ST segment at the electrocardiography, and intensity of pain inpatients presenting with chest pain to emergency department

Introduction and purposeChest pain is one of the frequent reasons for applying to the emergency deparment. With regard to the cases who apply with the CP complaint, it might not be always possible to diagnose `acute coronary syndrome? which requires early management. For some group of patients, in order to diagnose it is required to observe either clinically or electrocardiographically. In literature, we did not find any study that shows the correlation between intensity of chest-pain and the ST segment deviation in ECG as likelihood of ACS. In this study we aimed to reveal the correlation between intensity of chest-pain and likelihood of ACS and ST segment deviation in ECG of the patients who have chest-pain.Material and MethodThe study was conducted between March 15, 2007 to June 15 2007. All of 18 years-old and older patients who have chest-pain to apply consecutively the emergency department were taken to the study. The patients who refused to participate in the study, who did not cooperate and orient and whose vital diagnosis are not stable and also require urgent conduction are excluded from the study.After performing primary conduction to the patients, the intensity of chest-pain was asked according to Numerical Rating Scale (NRS) and ECG?s were taken on admission and when their chest pain ceased.The ST segment deviations in these ECG?s have been evaluated from an attending physician who presented in the study but not in the patient care. The changes according to isometric line in derivation which has utmost ST segment deviation has been measured visually by a ruler.The relationship between NRS scores recorded on admission and ST segment deviation in ECG, troponin levels and probability of ACS were analyzed.RESULTSOne hundred and twenty nine of 232 patients included to the study were male (%55.6). Mean of NRS scores on admission was 5,5+2,8 (range 1-10). There were no significant statistical differences between means of NRS scores for female and male patients in the study (p=0,693).Means of NRS scores of 136 patients who have no ST deviation and 96 patients who have ST deviation were found 5,3 ? 2,8 and 5,7+2,8 respectively (p=0,281). Means of NRS scores of 126 patiens diagnosed ACS and 106 patients nondiagnosed ACS were found 5,6+2,9 and 5,4+2,7 respectively (p=0.853).CONCLUSSİONNo relationship was determined among the means of NRS scores that represent intensity of chest-pain and ST segment abnormality on ECG and likelihood of ACS in our study.Therefore, we can say that, there is no predictive value of using NRS scores for ACS diagnosis in the patients who have chest-pain in emergency department. We don?t need to ask the severity of chest pain for these patients.