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52 Routine versus clinically indicated use of chest X-rays in patients presenting with ST-elevation myocardial infarction
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  1. Noor Leelo1,
  2. Nicky Mortimer2,
  3. JN Townend2,
  4. SN Doshi2,
  5. M Adnan Nadir3
  1. 1University of Birmingham Medical School, Birmingham, UK
  2. 2Dept of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
  3. 3Queen Elizabeth Hospital Birmingham

Abstract

Background National Institute of Clinical Excellence (NICE) guidelines recommend consideration of Chest X-rays (CXRs) in patients presenting with chest pain to exclude non-cardiac causes of chest pains. However, patients with ST-segment elevation myocardial infarction (STEMI) have a clear diagnosis, rendering the rationale for routine CXRs in this cohort of patients unclear. However, this remains a common practice across the health service. This raises the question of whether CXRs should be conducted routinely or only when clinically indicated.

Methods We performed a retrospective study use of CXRs in consecutive patients admitted with STEMI undergoing primary percutaneous coronary intervention in a single UK tertiary cardiac center. We aimed to investigate if CXRs added clinical and diagnostic value by comparing routine vs. clinically indicated use.

Results A total of 122 patients (Mean Age 63±12, 87% Male) were admitted with STEMI during the study period and 114/122 (93.4%) patients received at least one CXR during their in-patient stay. All but 2/114 were portable thus resource-intensive. Of these, 75/114 (65.8%) were routine while 39/114 (34.2%) were clinically indicated. Although CXRs were performed in almost all the patients, only 56/114 (49.1%) of patients had the findings of CXRs documented in the clinical records. The diagnostic efficacy for CXR abnormalities was significantly higher in the clinically indicated CXR group (76.9%) rather than the routine CXR group (2.7%) (p = <0.001). The therapeutic efficacy was 53.8% for clinically indicated CXRs, whereas the routine CXRs had a therapeutic efficacy of 1.3% (p = <0.001). There was a significant association between CXR findings and whether the CXR requested was routine or not (X2 (1) = 70.07, p <0.001) and also management changes (X2 (1) = 45.43, p <0.001).

Conclusion Routine CXR in patient admitted with STEMI are often unnecessary and may add very little clinical value. On the other hand, selective post-procedural CXRs have a significantly higher diagnostic and therapeutic yield. Our study questions the rationale behind routine CXRs in the care of patients with STEMIs.

Conflict of Interest None to declare

  • STEMI
  • Acute Cardiac Care
  • Primary PCI

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