Comparison of non cardiac chest pain (NCCP) and acute coronary syndrome (ACS) patients presenting to a tertiary care center.

Om Parkash, Agha Khan University
Aysha Almas, Aga Khan University
Aamir Hameed, Aga Khan University
Muhammad Islam, Aga Khan University


OBJECTIVE: To compare clinical characteristics of patients admitted with chest pain with those who had Acute Coronary Syndrome (ACS) and Non Cardiac Chest Pain (NCCP) presenting at a tertiary care center.

METHODS: An analytical crossectional study was done. All patients presenting to the emergency with acute chest pain of age more than 18 years who had electrocardiography done and had an initial serum Troponin I (Trop I) measured were included. Patients were assigned to ACS groups or NCCP group after cardiac workup. Those who did not have cardiac workup were excluded from the study.

RESULTS: We enrolled a total of 202 patients. After workup 45.94% were placed in the ACS group and 34.5% in NCCP group. On comparison of the baseline characteristics of the ACS and NCCP group, there was significant difference in age (p <0.001) and Diabetes Mellitus (p <0.002). Comparison of clinical characteristics, showed a significant difference in the character of chest pain (p <0.001), electrocardiogram (p <0.001), -ve Troponin (Trop I) value (p <0.001), pulse (p <0.02) and presence of Pulmonary edema (p <0.006). Non ST elevation myocardial infarction (NSTEMI) (46.5%)was the most common diagnosis in the ACS group and Muscular pain (27.60%) was the most common diagnosis in the NCCP group.

CONCLUSION: Patients with NCCP were younger, majority were non- diabetics, had slower pulse, more atypical/non-cardiac chest pain, had more normal ECG at base line as compared to patients with ACS. Muscular chest pain was the most common diagnosis in NCCP and NSTEMI in ACS group.