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Clinical Diagnosis of ACS

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14 papers 0 to 25 followers
By Aaron Guinn Canadian emergency medicine physician - clinical diagnosis, sepsis and tox
Edward W Carlton, Louise Cullen, Martin Than, James Gamble, Ahmed Khattab, Kim Greaves
OBJECTIVE: To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared the diagnostic accuracy of this ADP with strategies using initial undetectable hs-cTnT. METHODS: This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS...
July 2015: Heart: Official Journal of the British Cardiac Society
Bernadette Meller, Louise Cullen, William A Parsonage, Jaimi H Greenslade, Sally Aldous, Tobias Reichlin, Karin Wildi, Raphael Twerenbold, Cedric Jaeger, Petra Hillinger, Philip Haaf, Christian Puelacher, Vera Kern, Katharina Rentsch, Fabio Stallone, Maria Rubini Gimenez, Paola Ballarino, Stefano Bassetti, Astrid Walukiewicz, Richard Troughton, Christopher J Pemberton, A Mark Richards, Kevin Chu, Christopher M Reid, Martin Than, Christian Mueller
BACKGROUND: We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI. METHODS: In two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings...
April 1, 2015: International Journal of Cardiology
Hualan Huang, Shuai Zhu, Weiqing Wang, Hong Yi, Xiangyang Du, Xin Nie, Yong He, Haolan Song, Qiang Miao, Lanlan Wang, Guixing Li
BACKGROUND: The objective of this study was to examine the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for acute myocardial infarction (AMI) in patients with renal insufficiency, since this population has a high incidence of non-AMI elevations of hs-cTnT. METHODS: In this prospective study, we enrolled 2249 consecutive patients presenting with chest pain in the emergency department (ED), of whom 19.5% had an estimated glomerular filtration rate (eGFR)cys of <60 mL·min-1 (1...
April 2015: Clinical Chemistry and Laboratory Medicine: CCLM
Manon G van der Meer, Barbra E Backus, Yolanda van der Graaf, Maarten J Cramer, Yolande Appelman, Pieter A Doevendans, A Jacob Six, Hendrik M Nathoe
BACKGROUND: Previous studies suggested that diagnosing coronary artery disease (CAD) is more difficult in women than in men. Studies investigating the predictive value of clinical signs and symptoms and compare its combined diagnostic value between women and men are lacking. METHODOLOGY: Data from a large multicenter prospective study was used. Patients admitted to the emergency department (ED) with chest pain but without ST-elevation were eligible. The endpoint was proven CAD, defined as a significant stenosis at angiography or the diagnosis of a non-ST-elevation myocardial infarction or cardiovascular death within six weeks after presentation at the ED...
2015: PloS One
Tim Harris, Keith McDonald
OBJECTIVE: To benchmark walk-in presentations to emergency departments (ED) with those presenting to other local acute healthcare facilities. SETTING: A large teaching hospital with an annual ED census of 140, 000 adult patients and surrounding associated acute healthcare providers. METHODS: A random sample of 384 patients who self-presented to the ED was obtained. Benchmarking data were drawn from two general practices; the Tower Hamlets Community Services walk-in centre (co-located on-site with the ED) and the GP-run out-of-hours service...
December 2014: Emergency Medicine Journal: EMJ
Anniek Visser, Albert Wolthuis, Rob Breedveld, Ewoud ter Avest
BACKGROUND: Acute coronary syndrome (ACS) can be a diagnostic challenge in the emergency department (ED). Recently, the HEART score was developed, a simple bedside scoring system that quantifies risk of ischaemic events in patients with undifferentiated chest pain presenting in the ED. OBJECTIVE: In this prospective cohort study, we compared the diagnostic accuracy of HEART score and clinical gestalt (clinical judgement) for diagnosing ACS in an unselected population of patients with chest pain presenting to the ED...
August 2015: Emergency Medicine Journal: EMJ
Martin Than, Dylan Flaws, Sharon Sanders, Jenny Doust, Paul Glasziou, Jeffery Kline, Sally Aldous, Richard Troughton, Christopher Reid, William A Parsonage, Christopher Frampton, Jaimi H Greenslade, Joanne M Deely, Erik Hess, Amr Bin Sadiq, Rose Singleton, Rosie Shopland, Laura Vercoe, Morgana Woolhouse-Williams, Michael Ardagh, Patrick Bossuyt, Laura Bannister, Louise Cullen
OBJECTIVE: Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could safely increase the proportion of patients suitable for early discharge. METHODS: Logistic regression identified statistical predictors for major adverse cardiac events in a derivation cohort...
February 2014: Emergency Medicine Australasia: EMA
Nadia A Khan, Stella S Daskalopoulou, Igor Karp, Mark J Eisenberg, Roxanne Pelletier, Meytal Avgil Tsadok, Kaberi Dasgupta, Colleen M Norris, Louise Pilote
IMPORTANCE: Little is known about whether sex differences in acute coronary syndrome (ACS) presentation exist in young patients and what factors determine absence of chest pain in ACS presentation. OBJECTIVES: To evaluate sex differences in ACS presentation and to estimate associations between sex, sociodemographic, gender identity, psychosocial and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS. DESIGN, SETTING, PARTICIPANTS: We conducted a prospective cohort study of 1015 patients (30% women) 55 years or younger, hospitalized for ACS and enrolled in the GENESIS PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) study (January 2009-September 2012)...
November 11, 2013: JAMA Internal Medicine
Ethan J Halpern, Jacob P Deutsch, Maria M Hannaway, Adrian T Estepa, Anand S Kenia, Kenneth J Neuburger, David C Levin
OBJECTIVE: The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome. METHODS: Informed consent was obtained from consecutive ED patients who presented with chest pain and were evaluated with coronary computed tomography angiography (cCTA). Cardiac risk factors, clinical presentation, electrocardiogram, and laboratory studies were recorded; the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) scores were tabulated...
October 2013: American Journal of Emergency Medicine
Frank Xavier Scheuermeyer, Hubert Wong, Eugenia Yu, Barb Boychuk, Grant Innes, Eric Grafstein, Kenneth Gin, Jim Christenson
UNLABELLED: ABSTRACTObjectives:Current guidelines emphasize that emergency department (ED) patients at low risk for potential ischemic chest pain cannot be discharged without extensive investigations or hospitalization to minimize the risk of missing acute coronary syndrome (ACS). We sought to derive and validate a prediction rule that permitted 20 to 30% of ED patients without ACS safely to be discharged within 2 hours without further provocative cardiac testing. METHODS: This prospective cohort study enrolled 1,669 chest pain patients in two blocks in 2000-2003 (development cohort) and 2006 (validation cohort)...
2013: CJEM
Stephen P J Macdonald, Yusuf Nagree, Daniel M Fatovich, Simon G A Brown
AIM: The Thrombolysis in Myocardial Infarction (TIMI) risk score (range 0-7), used for emergency department (ED) risk stratification of patients with suspected acute coronary syndrome (ACS), underestimates risk associated with ECG changes or cardiac troponin elevation. A modified TIMI score (mTIMI, range 0-10), which gives increased weighting to these variables, has been proposed. We aimed to evaluate the performance of the mTIMI score in ED patients with suspected ACS. METHODS: A multicentre prospective observational study enrolled patients undergoing assessment for possible ACS...
April 2014: Emergency Medicine Journal: EMJ
Judith M Poldervaart, A Jacob Six, Barbra E Backus, Hector W L de Beaufort, Maarten-Jan M Cramer, Rolf F Veldkamp, E Gijs Mast, Eugène M Buijs, Wouter J Tietge, Björn E Groenemeijer, Luc Cozijnsen, Alexander J Wardeh, Hester M den Ruiter, Pieter A Doevendans
BACKGROUND: To improve early diagnostic and therapeutic decision making, we designed the HEART score for chest pain patients in the emergency department (ED). HEART is an acronym of its components: History, ECG, Age, Risk factors and Troponin. Currently, many chest pain patients undergo exercise testing on the consecutive days after presentation. However, it may be questioned how much diagnostic value the exercise ECG adds when the HEART score is already known. METHODS: A subanalysis was performed of a multicenter prospective validation study of the HEART score, consisting of 248 patients who underwent exercise testing within 7 days after presentation in the ED...
April 2013: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Sally J Aldous, Mark Richards, Louise Cullen, Richard Troughton, Martin Than
BACKGROUND: Accelerated diagnostic pathways for risk stratification of patients presenting to the emergency department with potential acute coronary syndromes may identify very-low-risk patients safe for early discharge to outpatient care. METHODS: Patients presenting with potential acute coronary syndrome to the emergency department were prospectively enrolled between November 2007 and April 2010. Patient characteristics in conjunction with 0- and 2-hour biomarkers and electrocardiograms were analyzed according to a 2-hour thrombolysis in myocardial infarction (TIMI) score and 9 other accelerated diagnostic pathways...
October 2012: American Heart Journal
Anne-Maree Kelly
OBJECTIVE: To determine the rate of major adverse cardiac events (MACE) in patients assessed in an emergency department (ED) for chest pain with a non-ischaemic ECG, Thrombolysis in Myocardial Infarction (TIMI) score of 0 and initial troponin I (TnI) ≤99th centile. METHODS: This was a sub-study of a prospective observational study of adult patients with potentially cardiac chest pain who underwent evaluation for acute coronary syndrome in an urban teaching hospital...
January 2013: Emergency Medicine Journal: EMJ
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