pain radiation to right arm in ACS

How predictive is the history for acute coronary syndrome? Of 1576 patients entered into a multicentre evaluation of chest pain units, 132 (8.4%)  had ACS, as determined by positive troponin, CK-MB, or early treadmill test.
On multivariate analysis, only age, duration, sex and radiation of pain to the right arm were independently associated with ACS.
Likelihood ratios (95% CI) were:

  • radiation of pain to the right arm, 2.9 (95% CI 1.4 to 6.3)
  • male sex 1.2 (95% CI 1.0 to 1.3)
  • female sex 0.79 (95% CI 0.62 to 1.0).

The area under the receiver operator characteristic curve for age was 0.629 (95% CI 0.573 to 0.686) and for duration was 0.546 (95% CI 0.481 to 0.610).
The authors conclude that clinical features have very limited value for diagnosing ACS in patients with a normal or non- diagnostic ECG, and radiation of pain to the right arm increases the likelihood of ACS.
Clinical diagnosis of acute coronary syndrome in patients with chest pain and a normal or non-diagnostic electrocardiogram.
Emerg Med J. 2009 Dec;26(12):866-70