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Pain severity does not predict outcomes with AMI

Clinical Question:
Does pain severity correlate with worse outcomes in patients with potential acute coronary syndrome?

Bottom Line:
Degree of chest pain does not predict outcome in patients with potential acute coronary syndrome. Severe pain -- a score of 9 or 10 on a scale of 1-10 -- is no more likely to predict acute myocardial infarction or the composite outcome of death, vascularization, or acute myocardial infarction than lower pain scores. (LOE = 1b)

Reference:
Edwards M, Chang AM, Matsuura AC, Green M, Robey JM, Hollander JE. Relationship between pain severity and outcomes in patients presenting with potential acute coronary syndromes. Ann Emerg Med 2011;58(6):501-507.  [PMID:21802776]

Study Design:
Cohort (prospective)

Funding:
Self-funded or unfunded

Setting:
Emergency department

Synopsis:
As part of another study, 3306 patients with acute chest pain documented at triage were followed up to determine their outcomes over the next 30 days. Fifty-seven percent of patients were women, 66% were black, and their average age was 51.0 years. Follow-up occurred for 93% of patients. Over 30 days, 34 patients died, 105 underwent revascularization, and 11 experienced acute myocardial infarction. Severe pain, defined as a score of 9 or 10 on a standard 0 to 10 pain scale, was reported by 18% of patients and was not related to acute myocardial infarction or a composite of all outcomes as compared with lesser degrees of pain.

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