Objective: To identify correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales.
Design: Prospective cohort study.
Setting: The emergency departments of three university and four community hospitals.
Patients: Five hundred patients more than 30 years of age presenting to the emergency departments between 1984 and 1985 with a chief complaint of chest pain not explained by obvious trauma or chest x-ray abnormalities, and more than bibasilar rales on physical examination.
Measurements and main results: A standard data form was used to collect the history, physical examination, vital sign, and electrocardiographic findings. Chart review was carried out to record complications and mortality. One hundred eleven (22%) of the patients had a major complication (ventricular fibrillation, Mobitz II heart block, complete heart block, atrioventricular dissociation, cardiogenic shock, cardiac arrest, endotracheal intubation, intra-aortic balloon pump) or died, 160 (32%) were diagnosed as having myocardial infarction, and 58 (12%) died. Of those patients who had major complications or who died, the first complication occurred within six hours of hospital admission for 32% of the patients and within 24 hours for 47% of the patients. Univariate correlates (p < 0.10) of a major complication or death were entered into a stepwise logistic regression model. In the multivariate model, ST elevation or Q waves not known to be old [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI) 3.0-11.1], ST-T changes of ischemia not known to be old (OR 2.6, 95% CI 1.5-4.6), systolic blood pressure < or = 120 mm Hg (OR 3.2, 95% CI 1.9-5.6), and age > 70 years (OR 1.8, 95% CI 1.1-3.0) were correlates of a major complication or death.
Conclusion: For patients presenting to the emergency department with chest pain and more than bibasilar rales, major electrocardiographic changes, systolic blood pressure < or = 120 mm Hg, and age > 70 years were correlated with a higher risk of a major complication or death.