• M H Chin, E F Cook, T H Lee, and L Goldman.
• Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115.
• J Gen Intern Med. 1994 Dec 1;9(12):659-65.

ObjectiveTo identify correlates of major complications and mortality in patients presenting to the emergency department with chest pain and more than bibasilar rales.DesignProspective cohort study.SettingThe emergency departments of three university and four community hospitals.PatientsFive hundred patients more than 30 years of age presenting to the emergency departments between 1984 and 1985 with a chief complaint of chest pain not explained by obvious trauma or chest x-ray abnormalities, and more than bibasilar rales on physical examination.Measurements And Main ResultsA standard data form was used to collect the history, physical examination, vital sign, and electrocardiographic findings. Chart review was carried out to record complications and mortality. One hundred eleven (22%) of the patients had a major complication (ventricular fibrillation, Mobitz II heart block, complete heart block, atrioventricular dissociation, cardiogenic shock, cardiac arrest, endotracheal intubation, intra-aortic balloon pump) or died, 160 (32%) were diagnosed as having myocardial infarction, and 58 (12%) died. Of those patients who had major complications or who died, the first complication occurred within six hours of hospital admission for 32% of the patients and within 24 hours for 47% of the patients. Univariate correlates (p < 0.10) of a major complication or death were entered into a stepwise logistic regression model. In the multivariate model, ST elevation or Q waves not known to be old [adjusted odds ratio (OR) 5.8, 95% confidence interval (CI) 3.0-11.1], ST-T changes of ischemia not known to be old (OR 2.6, 95% CI 1.5-4.6), systolic blood pressure < or = 120 mm Hg (OR 3.2, 95% CI 1.9-5.6), and age > 70 years (OR 1.8, 95% CI 1.1-3.0) were correlates of a major complication or death.ConclusionFor patients presenting to the emergency department with chest pain and more than bibasilar rales, major electrocardiographic changes, systolic blood pressure < or = 120 mm Hg, and age > 70 years were correlated with a higher risk of a major complication or death.

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