Takeaway
- The risk for type-A aortic dissection (TAAD) being treated as an acute coronary syndrome (ACS) is significant in patients presenting with ST changes and elevated cardiac enzymes.
Why this matters
- Implementation of more robust chest pain algorithms may help to increase awareness and use of investigations that can be used to make or exclude TAAD diagnosis.
Study design
- A “chest pain survey” containing 13 questions was distributed to emergency department (ED) consultants across the UK to assess the range of components of TAAD diagnosis and management.
- The survey was divided into 3 categories:
- initial diagnosis/management,
- AD-specific investigations and
- infrastructure to facilitate diagnosis/referral to cardiothoracic services.
- Funding: None.
Key results
- Overall, 98% of ED consultants felt that chest pain and ST elevation were sufficient to make a diagnosis of ACS and 58.4% considered the above criteria sufficient to proceed to ACS treatment (including thrombolysis).
- The initial commitment to the diagnosis of myocardial infarction (OR, 0.31; 95% CI, 0.12-0.83; P=.02) and overlooking signs of unilateral pulse deficit (OR, 0.62; 95% CI, 0.42-0.90; P=.013) were associated with low likelihood to send the patients for CT scan.
- Overall, 31.7% of ED consultants reported they would never request a CT chest in patients with chest pain and elevated troponin.
- The absence of an AD algorithm was associated with the use of d-dimer (in the context of troponin positivity) as a useful investigation for differentiating causes of chest pain (OR, 0.31; 95% CI, 0.01-0.64; P=.05).
Limitations
- The estimated response rate (<5%) may not accurately reflect ED practice nationally.
References
References
