Reliability of Three Sets of Cardiac Enzymes in the Setting of Acute Chest Pain in Patients at Low Risk for Acute Coronary Syndrome in the Emergency Department

2005 ◽  
Vol 46 (3) ◽  
pp. 59
Author(s):  
L. Papa ◽  
C.R. Shaw ◽  
E. Rees ◽  
B. Goldfeder ◽  
D. Meurer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Low Risk ◽  
Cardiac Enzymes ◽  
Coronary Syndrome

scholarly journals External validation of an emergency department triage algorithm for chest pain patients

2020 ◽  
Vol 9 (6) ◽  
pp. 576-585
Author(s):  
Òscar Miró ◽  
Pedro Lopez-Ayala ◽  
Gemma Martínez-Nadal ◽  
Valentina Troester ◽  
Ivo Strebel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Low Risk ◽  
Single Centre ◽  
Coronary Syndrome ◽  
Emergency Department Triage ◽  
Model C ◽  
Triage Algorithm ◽  
Pain Patients

Background We aimed to externally validate an emergency department triage algorithm including five hierarchical clinical variables developed to identify chest pain patients at low risk of having an acute coronary syndrome justifying delayed rather than immediate evaluation. Methods In a single-centre cohort enrolling 29,269 consecutive patients presenting with chest pain, the performance of the algorithm was compared against the emergency department discharge diagnosis. In an international multicentre study enrolling 4069 patients, central adjudication by two independent cardiologists using all data derived from cardiac work-up including follow-up served as the reference. Triage towards ‘low-risk’ required absence of all five clinical ‘high-risk’ variables: history of coronary artery disease, diabetes, pressure-like chest pain, retrosternal chest pain and age above 40 years. Safety (sensitivity and negative predictive value (NPV)) and efficacy (percentage of patients classified as low risk) was tested in this initial proposal (Model A) and in two additional models: omitting age criteria (Model B) and allowing up to one (any) of the five high-risk variables (Model C). Results The prevalence of acute coronary syndrome was 9.4% in the single-centre and 28.4% in the multicentre study. The triage algorithm had very high sensitivity/NPV in both cohorts (99.4%/99.1% and 99.9%/99.1%, respectively), but very low efficacy (6.2% and 2.7%, respectively). Model B resulted in sensitivity/NPV of 97.5%/98.3% and 96.1%/89.4%, while efficacy increased to 14.2% and 10.4%, respectively. Model C resulted in sensitivity/NPV of 96.7%/98.6% and 95.2%/91.3%, with a further increase in efficacy to 23.1% and 15.5%, respectively. Conclusion A triage algorithm for the identification of low-risk chest pain patients exclusively based on simple clinical variables provided reasonable performance characteristics possibly justifying delayed rather than immediate evaluation in the emergency department.

scholarly journals 0043: Prognosis of patients admitted with chest pain in emergency department and discharged with low risk of acute coronary syndrome

2015 ◽  
Vol 7 (1) ◽  
pp. 109
Author(s):  
Gaëlle Haziza ◽  
Nathalie Cueille ◽  
Julien Magne ◽  
Dominique Cailloce ◽  
Patrice Virot ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Low Risk ◽  
Coronary Syndrome

scholarly journals COMPARATIVE ANALYSIS OF VARIOUS RISK ASSESSMENT SCORES FOR LOW RISK ACUTE CORONARY SYNDROME IN AN INDIAN SCENARIO – AN ED BASED OBSERVATIONAL STUDY.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Zahid Shaikh ◽  
V. S. Shinde ◽  
Sumalya Tripathi ◽  
Dhiraj Jadhav ◽  
Ishan Lamba ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Tertiary Care ◽  
Acute Chest Pain ◽  
Industrial Area ◽  
Low Risk ◽  
Cardiac Biomarkers ◽  
Assessment Scores ◽  
Heart Score ◽  
Coronary Syndrome

Chest pain is one of the most common presentation to emergency department (ED). The misdiagnosis or over-diagnosis of patients with acute chest pain can be associated with serious clinical events or is time-consuming and this places a heavy burden on overcrowded and resource constraint ED. To help overcome this issue various scores are formed to rule out acute coronary syndrome (ACS) in these patients. Those who do not meet the criteria of high risk ACS like raised cardiac biomarkers, ECG changes, etc are labeled as low risk ACS. These patients form the majority of patients. A multitude of risk score have been formulated to predict the outcome and risk stratify patients with chest pain. Our objective was to evaluate the utility of these score in Indian setting in low risk ACS patients. We studied the various risk prediction score of 100 patients presenting to the ED of tertiary care teaching institute in an urban industrial area with low risk ACS. The scores that were calculated included HEART, TIMI, ADAPT, GRACE, NACPR and EDACS. Of all the scores only the HEART score correlated well with identifying those who required further testing. Taking a score of less than 3 as a marker of low risk ACS we get a sensitivity of 95.83% (95CI - 89.67% to 98.85%) and specificity of 100%. The PPV is 100% and accuracy of 96%. All other scores were either not specific enough or had limited utility. Keywords: Low risk ACS, ACS, HEART, TIMI, ADAPT, GRACE, NACPR, EDACS

Comparative Prospective Study of the Performance of Chest Pain Scores and Clinical Assessment in an Emergency Department Cohort in Singapore

2020 ◽  
Author(s):  
Ng Mingwei ◽  
Hong Jie Gabriel Tan ◽  
Fei Gao ◽  
Jack Wei Chieh Tan ◽  
Swee Han Lim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Assessment ◽  
Clinical Judgment ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Pain Scores ◽  
Pain Patients

Abstract Background Chest pain scores allow emergency physicians to identify low-risk patients for whom discharge can be safely expedited. While their utility have been extensively studied and validated in Western cohorts, data in patients of Asian heritage is lacking. This study aimed to determine the accuracy of HEART, EDACS and GRACE in risk-stratifying which emergency patients with chest pain or angina-equivalent symptoms are at risk of major adverse cardiovascular events (MACE) within 30 days (composite of all-cause mortality, acute myocardial infarction, and coronary revascularization). This single-centre prospective cohort-study enrolling 1200 patients was conducted by a large urban tertiary centre in Singapore. The chest pain scores were reported prior to disposition by research assistants blinded to the physician’s clinical assessment. Outcome adjudication was performed by an independent blinded cardiologist and emergency physician, while a second cardiologist adjudicated in the case of discrepancies. \Results Of 1200 patients enrolled, 5 withdrew consent and were excluded from analyses. 135 patients (11.3%) suffered MACE within 30 days. HEART, which ruled-out acute coronary syndrome in 52.8% of patients with 88.1% sensitivity, and EDACS, which ruled-out acute coronary syndrome in 57.5% of patients with 83.7% sensitivity, proved comparable to clinical judgment which ruled-out acute coronary syndrome in 73.0% of patients with 85.5% sensitivity. GRACE was weaker – ruling-out acute coronary syndrome in 79.2% of patients but with a dismal sensitivity of 45.0%. The correlation-statistic for HEART (79.4%) was also superior to EDACS (69.9%) and GRACE (69.2%). Conclusions HEART more accurately identified low-risk chest pain patients in an Asian emergency department who were suitable for expedited discharge and demonstrated comparable performance characteristics to clinical judgment. This has major implications on the use of chest pain scores to safely expedite disposition decisions for low-risk chest pain patients in the emergency department.

scholarly journals Current Role of Computed Tomography in the Evaluation of Acute Coronary Syndrome

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 266
Author(s):  
Min Ji Son ◽  
Seung Min Yoo ◽  
Dongjun Lee ◽  
Hwa Yeon Lee ◽  
In Sup Song ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
Review Article ◽  
Current Role ◽  
Coronary Syndrome ◽  
Ct Findings

This review article provides an overview regarding the role of computed tomography (CT) in the evaluation of acute chest pain (ACP) in the emergency department (ED), focusing on characteristic CT findings.

Sign in / Sign up

Export Citation Format

Share Document