To the Editor: In their Clinical Review, Drs Swap and Nagurney1 identified studies evaluating elements of the clinical history that may be helpful in diagnosing acute coronary syndrome (ACS) in patients with chest pain. Unfortunately, their literature search seems to have missed a relevant study.2 In 2003, my colleagues and I reported a prospective evaluation of 972 patients presenting to an emergency department with acute undifferentiated chest pain. We used multivariate analysis to identify clinical features that had an independent association with ACS. We found that vomiting (likelihood ratio [LR] 3.5; 95% confidence interval [CI], 2.0-6.2), pain radiating to the left arm (LR 1.3; 95% CI, 0.9-1.8) or right arm (LR 3.8; 95% CI, 2.2-6.6), and previous smoking (LR 2.5; 95% CI, 1.6-4.0) or current smoking (LR 1.4; 95% CI, 1.04-1.8) were useful for diagnosing ACS.
Goodacre S. Cocktails for Two. JAMA. 2006;295(19):2248–2249. doi:10.1001/jama.295.19.2249-a
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