- Academic Editor
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Background: Acute coronary syndrome (ACS) is a major cause of morbidity
and mortality in the western world. Classic angina pectoris (AP) is a common
reason to request prehospital emergency medical services (EMS). Nevertheless,
data on diagnostic accuracy and common misdiagnoses are scarce. Therefore, the
aim of this study is to evaluate the amount and variety of misdiagnoses and
assess discriminating features. Methods: For this retrospective cohort
study, all patients requiring EMS for suspected ACS in the city of Bonn (Germany)
during 2018 were investigated. Prehospital and hospital medical records were
reviewed regarding medical history, presenting signs and symptoms, as well as
final diagnosis. Results: Out of 740 analyzed patients with prehospital
suspected ACS, 283 (38.2%) were ultimately diagnosed with ACS (ACS group).
Common diagnoses in the cohort with non-confirmed ACS (nACS group) consisted of
unspecific pain syndromes, arrhythmias, hypertensive crises, and heart failure.
ST segment elevation (adjusted odds-ratios [adj. OR] 2.70), male sex (adj. OR
1.71), T wave changes (adj. OR 1.27), angina pectoris (adj. OR 1.15) as well as
syncope (adj. OR 0.63) were identified among others as informative predictors in
a multivariable analysis using the lasso technique for data-driven variable
selection. Conclusions: Misdiagnosed ACS is as common as 61.8% in this
cohort and analyses point to a complex of conditions and symptoms (i.e., male
sex, electrocardiographic (ECG) changes, AP) for correct ACS diagnosis while
neurological symptoms were observed significantly more often in the nACS group
(e.g., Glasgow Coma Scale (GCS)