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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)

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)

Self-funded or unfunded

Emergency department

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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