Info

Composite outcomed

393 (90.3)

67 (76.1)

114 (69.9)

51 (73.9)

<0.0001

aValues are medians (25th, 75th percentiles) or frequencies (percentages). bBundle-branch block, ventricular hypertrophy, idioventricular, or paced rhythms. cMultiple outcomes are possible.

dThe occurrence of death, MI, or revascularization by 30 d. Adapted from ref. 20.

aValues are medians (25th, 75th percentiles) or frequencies (percentages). bBundle-branch block, ventricular hypertrophy, idioventricular, or paced rhythms. cMultiple outcomes are possible.

dThe occurrence of death, MI, or revascularization by 30 d. Adapted from ref. 20.

3 vessel 15%

Fig. 1. Extent of coronary artery disease in 720 patients with unstable angina or non-Q wave infarction who underwent angiography in TIMI Illb. Data from ref. 30.

Conversely, 2-10% of patients sent home from the ED after initial evaluation of their symptoms will actually have had an unrecognized acute MI (25,31-33); up to 25% of these are due to misinterpretation of the initial 12-lead ECG (25,32). Approximately 25% of patients sent home from the ED with an unrecognized MI may die (25,31,32). This figure, coupled with the recognition that the leading cause of malpractice litigation against ED physicians (about 20% of awards), is related to misdiagnosis of acute MI in this minority of patients (34), creates understandable pressure for ED physicians to admit a large proportion of the chest pain patients they see. This practice pattern leads to significant drains on limited in-hospital resources, including beds and nursing staff, and results in an estimated $600 million in hospital costs annually for patients without a coronary etiology for their symptoms (35).

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