Regional wall motion abnormalities on focused transthoracic echocardiography in patients presenting with acute chest pain: a predefined post hoc analysis of the prospective single-centre observational EPIC-ACS study.

Objectives: We evaluated the ability of the assessment of regional wall motion abnormalities (RWMA) detected via transthoracic echocardiography to predict the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department.

Design: Prospective single-centre observational study.

Setting: Tertiary care university hospital emergency unit.

Participants: Patients presenting to the emergency department with acute chest pain suggestive of obstructive CAD.

Primary Outcome Measure: The primary endpoint was defined as the presence of obstructive CAD, requiring revascularisation therapy.

Results: Overall, 657 patients (age 58.1±18.0 years, 53% men) were included in our study. RWMA were detected in 76 patients (11.6%). RWMA were significantly more frequent in patients reaching the primary endpoint (26.2% vs 7.6%, p<0.001). In multivariable regression analysis, the presence of RWMA was associated with threefold increased odds of the presence of obstructive CAD (3.41 (95% CI 1.99 to 5.86), p<0.001). Adding RWMA to a multivariable model of the Thrombolysis in Myocardial Infarction (TIMI) risk score, cardiac biomarkers and traditional risk factors significantly improved the area under the curve for prediction of obstructive CAD (95% CI 0.777 to 0.804, p=0.0092).

Conclusion: RWMA strongly and independently predicts the presence of obstructive CAD in patients presenting with acute chest pain to the emergency department.

Trial Registration: The study has been registered online (NCT03787797).