Predictive Symptoms for Acute Coronary Syndrome in Aboriginal and Torres Strait Islander People Assessed in the Emergency Department

Résumé fourni par la source

OBJECTIVE: To compare the symptomatology of Aboriginal and Torres Strait Islander and non-Indigenous patients presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) and to determine whether specific symptoms increased the odds of ACS diagnosis and whether traditional groupings of typical or atypical symptoms are relevant in these populations. METHODS: Prospectively collected symptom data from 1643 adult patients presenting at two Queensland emergency departments between 2011-2014 and 2016-2019 who were assessed for suspected ACS were analysed according to self-reported Indigenous status. ACS diagnosis was the primary outcome. RESULTS: In 1643 patients investigated for suspected ACS, chest pain (92.1%), diaphoresis (47.8%), and shortness of breath (52.2%) were the most reported symptoms. For the 194 patients diagnosed with ACS, chest pain was reported less frequently in Aboriginal and Torres Strait Islander patients compared with non-Indigenous patients (81.5% vs. 94.2%, p = 0.009). For Aboriginal and Torres Strait Islander patients, vomiting and indigestion were associated with increased odds of ACS; left-sided chest pain or sharp pain was associated with decreased odds. Aboriginal and Torres Strait Islander patients with ACS were more likely to present atypically than non-Indigenous patients, but typicality was not associated with ACS. CONCLUSION: Clinicians must have a high index of suspicion for ACS in Aboriginal and Torres Strait Islander people with chest pain who present with symptoms of gastrointestinal upset such as indigestion or vomiting. Typical or atypical groupings of ACS symptoms are of limited value or relevance in Australian populations, and these terms should be phased out. TRIAL REGISTRATION: ANZCRN12617000756325.

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