Frequency of acute coronary syndrome in patients presenting to the Emergency Department with chest pain after methamphetamine use

Background: Prompt treatment of acute coronary syndrome (ACS) has been shown to reduce mortality and morbidity; yet many patients delay seeking care. In order to receive timely care, symptoms of ACS need to be recognized, interpreted, and acted upon. Patients who experience symptoms matching their expectations and those with correct symptom attribution are more likely to use emergency medical services (EMS) as a means of transportation to the hospital. The connection between symptom type and EMS use has not been fully explored. Purpose: To assess if clusters of presenting symptoms are associated with EMS transportation to the emergency department (ED) in patients with ACS and to evaluate if EMS transportation or symptom clusters are associated with prehospital delay time. Methods: A secondary analysis was conducted from the PROMOTION trial, a randomized controlled trial to reduce patient prehospital delay in ACS. Results: Of the 3,522 subjects with coronary artery disease enrolled, 3,087 completed 2-year follow-up. Of these, 331 subjects visited an ED for ACS symptoms during follow-up. Among the 331, 84% (278) had mode of transportation documented; 44% arrived by EMS. Having classic ACS symptoms (chest pain, pressure, or discomfort) in combination with pain symptoms (AOR=2.66, p = 0.011), classic ACS symptoms in combination with stress symptoms (AOR=2.61, p = 0.007) or classic ACS symptoms in combination with both pain and stress symptoms (AOR=3.90, p = 0.012) were associated with higher odds of arriving to the ED by EMS compared to classic ACS symptoms alone. Among 260 patients with prehospital delay time available, arriving by EMS decreased median delay time by 68.5 minutes compared to those with other transportation, after accounting for symptom clusters, patient and study characteristics (p = 0.002). Symptom clusters did not predict delay time in adjusted modeling (p = 0.952). Conclusion: While chest pain was the most prevalent symptom of ACS for most (85%), these findings suggest that it is the cluster of classic ACS symptoms with other types of symptom that motivate patients to use EMS. With less than half of patients using EMS, further research is needed to better understand how symptom clusters influence care-seeking behavior.

Download Full-text

Development of a Clinical Prediction Rule for 30-Day Cardiac Events in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.07.026 ◽

2012 ◽

Vol 59 (2) ◽

pp. 115-125.e1 ◽

Cited By ~ 89

Author(s):

Erik P. Hess ◽

Robert J. Brison ◽

Jeffrey J. Perry ◽

Lisa A. Calder ◽

Venkatesh Thiruganasambandamoorthy ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

Clinical Prediction ◽

Cardiac Events ◽

Coronary Syndrome ◽

Emergency Department Patients

Download Full-text

Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease

Critical Pathways in Cardiology ◽

10.1097/hpc.0000000000000091 ◽

2016 ◽

Vol 15 (4) ◽

pp. 138-144 ◽

Cited By ~ 1

Author(s):

Matthew T. Crim ◽

Scott A. Berkowitz ◽

Mustapha Saheed ◽

Jason Miller ◽

Amy Deutschendorf ◽

...

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Risk Score ◽

Coronary Syndrome ◽

Artery Disease ◽

Pain Patients

Download Full-text

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

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620903452 ◽

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.

Download Full-text

Diagnostic performance of mean platelet volume for patients with acute coronary syndrome visiting an emergency department with acute chest pain: the Chinese scenario

Emergency Medicine Journal ◽

10.1136/emj.2010.093096 ◽

2010 ◽

Vol 28 (7) ◽

pp. 569-574 ◽

Cited By ~ 31

Author(s):

H. Chu ◽

W.-L. Chen ◽

C.-C. Huang ◽

H.-Y. Chang ◽

H.-Y. Kuo ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Mean Platelet Volume ◽

Diagnostic Performance ◽

Acute Chest Pain ◽

Platelet Volume ◽

Coronary Syndrome

Download Full-text

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

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)71798-2 ◽

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

Download Full-text

Variation of Cardiac Troponin I and T Measured with Sensitive Assays in Emergency Department Patients with Noncardiac Chest Pain

Clinical Chemistry ◽

10.1373/clinchem.2011.179903 ◽

2012 ◽

Vol 58 (8) ◽

pp. 1208-1214 ◽

Cited By ~ 27

Author(s):

Volkher Scharnhorst ◽

Krisztina Krasznai ◽

Marcel van 't Veer ◽

Rolf H Michels

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Myocardial Necrosis ◽

High Sensitivity ◽

Noncardiac Chest Pain ◽

Short Term ◽

Coronary Syndrome ◽

Concentration Changes

Abstract BACKGROUND New-generation high-sensitivity assays for cardiac troponin have lower detection limits and less imprecision than earlier assays. Reference 99th-percentile cutoff values for these new assays are also lower, leading to higher frequencies of positive test results. When cardiac troponin concentrations are minimally increased, serial testing allows discrimination of myocardial infarction from other causes of increased cardiac troponin. We assessed various measures of short-term variation, including absolute concentration changes, reference change values (RCVs), and indices of individuality (II) for 2 cardiac troponin assays in emergency department (ED) patients. METHODS We collected blood from patients presenting with cardiac chest pain upon arrival in the ED and 2, 6, and 12 h later. Cardiac troponin was measured with the high-sensitivity cardiac troponin T (hs-cTnT) assay (Roche Diagnostics) and a sensitive cTnI assay (Siemens Diagnostics). Cardiac troponin results from 67 patients without acute coronary syndrome or stable angina were used in calculating absolute changes in cardiac troponin, RCVs, and II. RESULTS The 95th percentiles for absolute change in cardiac troponin were 8.3 ng/L for hs-cTnT and 28 ng/L for cTnI. Within-individual and total CVs were 11% and 14% for hs-cTnT and 18% and 21% for cTnI, respectively. RCVs were 38% (hs-cTnT) and 57% (cTnI). The corresponding log-normal RCVs were +46%/−32% for hs-cTnT and +76%/−43% for cTnI. II values were 0.31 (cTnI) and 0.12 (hs-cTnT). CONCLUSIONS The short-term variations and IIs of cardiac troponin were low in ED patients free of ischemic myocardial necrosis. The detection of cardiac troponin variation exceeding reference thresholds can help to identify ED patients with acute myocardial necrosis whereas variation within these limits renders acute coronary syndrome unlikely.

Download Full-text