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Dr. Cheng's point is well taken and directly supported by a study that my colleagues and I conducted, which showed that the availability of a prior electrocardiogram is associated with substantially better diagnostic accuracy for physicians who are assessing patients with acute chest pain in the emergency department,
particularly when the current tracing demonstrates changes consistent with ischemia or infarction. In a subset of 2,024 patients whose current tracings were abnormal, those without myocardial infarction were more than twice as likely to be dismissed (26% versus 12%) if a prior tracing was available and about 1.5 times as likely to avoid admission to a coronary-care unit (39% versus 27%).
I also give patients a copy of their abnormal electrocardiographic tracing, and I would be most interested in a prospective trial of the influence of wallet-sized prior electrocardiograms on the utilization of resources. Even if such cards become widely used, however, the test of time is still likely to play an important role in the assessment of patients with acute chest pain in the emergency department.
Impact of the availability of a prior electrocardiogram on the triage of the patient with acute chest pain.
I read with interest the editorial by Lee entitled “Chest Pain in the Emergency Department: Uncertainty and the Test of Time,” which was published in the September 1991 issue of the Mayo Clinic Proceedings (pages 963 to 965). Although Lee suggested several tests to assess acute chest pain in patients in the emergency department, he failed to mention a simple and inexpensive aid in the decision-making process—the availability of a prior electrocardiogram (ECG).