IJCS | Volume 32, Nº2, March/April 2019

160 Table 1 - Diagnosis of chest pain between the initial evaluation by the general practitioner and after the telecardiology Diagnoses General practitioner N (%) Telecardiologist N (%) Non-STEMI 1,477 (92.72) 89 (5.59) STEMI 74 (4.64) 174 (10.92) APE 40 (2.52) 212 (13.31) Tachyarrhythmia 2 (0.12) 20 (1.26) Unstable angina 0 385 (24.17) CHF 0 289 (18.14) Hypertensive emergency 0 152 (9.54) ACRF 0 113 (7.09) Pneumonia 0 89 (5.59) Sepsis 0 39 (2.45) Myopericarditis 0 26 (1.63) OVD 0 5 (0.31) Total 1,593 1,593 Non-STEMI: non-ST-elevation acute myocardial infarction; STEMI: ST-segment elevation acute myocardial infarction; APE: acute pulmonary edema; CHF: congestive heart failure; OVD: orovalvar disease; ACRF: acute chronic renal failure. Table 2 - Outcome of patients with chest pain after evaluation by telecardiology Outcome after telecardiology N % Discharge 1,178 73.94% Transfer 338 21.21% Death 62 3.90% Unknown 15 0.95% Total 1,593 100% Table 3 - Main points of diagnostic disagreement between the general practitioner and the telecardiologist Points of diagnostic disagreement N % CPK/CKMB elevation with normal troponin 1,059 66.48 Troponin interpretation curve 305 19.15 Electrocardiography 227 14.25 Exclusive clinical evaluation 2 0.12 Total 1,593 100 Key: CPK: creatine phosphokinase; CPK: MB fraction of creatine phosphokinase. Farah et al. Diagnostic telecardiology in chest pain Int J Cardiovasc Sci. 2019;32(2)158-162 Original Article the telecardiologist, there was diagnostic agreement with the general practitioner from the UPA 24h in 72.61% of the cases (4,223 patients) and diagnostic disagreement in 27.39% of the cases (1,593 patients). In the group in which there was diagnostic disagreement, the general practitioner classified patients as follows: 1,477 (92.72%) non-ST-segment elevation acute myocardial infarction (NSTEMI), 74 (4.64%) ST segment elevation acute myocardial infarction (STEMI), 40 (2.52%) acute pulmonary edema (APE) and 2 (0.12%) tachyarrhythmia. After evaluation by telecardiology, the diagnoses were: 385 (24.17%) unstable angina (UA), 289 (18.14%) congestive heart failure (CHF), 212 (13.31%) APE, 174 (10.92%) STEMI, 152 (9.54%) hypertensive emergency (HE), 113 (7.09%) acute chronic renal failure (ACRF), 89 (5.59%) non- STEMI, 89 (5.59%) pneumonia, 39 (2.45%) sepsis, 26 (1.63%) myopericarditis, 20 (1.26%) tachyarrhythmia, 5 (0.31%) orovalvar disease (OVD). (Table 1). The general practitioner had requested intensive care admissions for the 1,593 patients identified by telecardiology as discordant diagnoses. After a careful evaluation by telecardiology, only 338 patients really needed to be transferred, and the great majority, 1,178 patients (73.94%), were discharged after clinical stabilization. Sixty-two (3.9%) patients died and 15 (0.95%) had an unknown outcome (Table 2). The main points of diagnostic disagreement identified by telecardiology are described in the following table. Discussion By analyzing the results found in this study, we observed the importance of telecardiology in remote