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Open Access Research article

Likelihood of acute coronary syndrome in emergency department chest pain patients varies with time of presentation

Ulf Ekelund1*, Mahin Akbarzadeh1, Ardavan Khoshnood1, Jonas Björk2 and Mattias Ohlsson3

Author Affiliations

1 Department of Emergency Medicine, Skåne University Hospital, Lund, SE-221 85, Sweden

2 Region Skåne competence centre for clinical research, Lund, Sweden

3 Department of Theoretical Physics, Lund University, Lund, Sweden

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BMC Research Notes 2012, 5:420  doi:10.1186/1756-0500-5-420

Published: 8 August 2012



There is a circadian and circaseptal (weekly) variation in the onset of acute coronary syndrome (ACS). The aim of this study was to elucidate whether the likelihood of ACS among emergency department (ED) chest pain patients varies with the time of presentation.


All patients presenting to the Lund ED at Skåne University Hospital with chest pain or discomfort during 2006 and 2007 were retrospectively included. Age, sex, arrival time at the ED and discharge diagnose (ACS or not) were obtained from the electronic medical records.


There was a clear but moderate circadian variation in the likelihood of ACS among presenting chest pain patients, the likelihood between 8 and 10 am being almost twice as high as between 6 and 8 pm. This was mainly explained by a variation in the ACS likelihood in females and patients under 65 years, with no significant variation in males and patients over 65 years. There was no significant circaseptal variation in the ACS likelihood.


Our results indicate that there is a circadian variation in the likelihood of ACS among ED chest pain patients, and suggest that physicians should consider the time of presentation to the ED when determining the likelihood of ACS.