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

Abstract Background: Patients presenting with chest pain (CP) at the emergency departments are challenging cases for the physicians to make valid decisions with regard to acute coronary syndrome, which needs urgent medical intervention while the majority of the admitted patients are free from serious cardiac problems. The present study was done to investigate the potential of Heart Risk Score in detecting the existence and severity of coronary artery disease in CP patients based on Syntax score.Methods: Among CP patients who were admitted at the emergency department, 100 participants were selected. Heart Risk Score was calculated for each participant on admission. Two independent cardiologists also calculated the Syntax score after angiography was done for each patient. Statistical analysis was performed to assess the correlation between Heart Risk Score and Syntax score.Results: The median age of participants was 58.42±12.42 with the majority (65%) being male. The mean Heart Risk Score of the patients was 5.76±1.56 (min=3, max=9) and the mean Syntax score was 14.82±11.42(min=0, max=44.5). Pearson correlation coefficient was 0.493 (P<0.001) between Heart Risk Score and Syntax score which was statistically significant (P<0.001). According to our findings a Heart Risk Score of more than 6 has a 52% sensitivity and a 74.7% specificity to detect extensive coronary artery involvement (Syntax score>22).Conclusion: We found that there is a positive and significant correlation between Heart Risk Score and Syntax score which underlines the importance of using Heart Risk Score in emergency departments to reduce unnecessary invasive interventions in patients presenting with chest pain.

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Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619853521 ◽

2019 ◽

Vol 9 (7) ◽

pp. 741-747 ◽

Cited By ~ 1

Author(s):

Agnes Wahrenberg ◽

Patrik KE Magnusson ◽

Andrea Discacciati ◽

Lina Ljung ◽

Tomas Jernberg ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Coronary Artery ◽

Family History ◽

Young Patients ◽

Coronary Syndrome ◽

History Of ◽

Artery Disease ◽

Pain Patients

Background: The value of family history of coronary artery disease (CAD) in diagnosing acute coronary syndrome (ACS) in chest pain patients is uncertain, especially in relation to high-sensitivity assays for cardiac troponin T (hs-cTnT), which have improved ACS diagnostics. Our objective was to investigate the association between verified family history of CAD and ACS in chest pain patients, overall and in different strata of initial hs-cTnT. Methods: Data on chest pain patients visiting four emergency departments in Sweden during 2013–2016 were cross-referenced with national registers of kinship, diseases and prescriptions. Family history of early CAD was defined as the occurrence of myocardial infarction or coronary revascularization before the age of 55 years in male and 65 years in female first-degree relatives. The outcome was combined including ACS and cardiovascular death within 30 days of presentation. Results: Of 28,188 patients, 4.7% of patients had ACS. In total, 8.2% and 32.4% had a family history of early and ever-occurring CAD, respectively. Family history of CAD was positively associated with the outcome, independently of age, gender, cardiovascular risk factors and electrocardiogram findings. The strongest association was observed for family history of early CAD (odds ratio 1.62, 95% confidence interval 1.35–1.94). Stronger associations were observed in young patients (e.g. <65 years) and in patients with non-elevated initial hs-cTnT levels ( p-value for interaction = 0.004 and 0.001, respectively). Conclusions: Family history of CAD is associated with ACS in chest pain patients, especially in patients of young age or with non-elevated initial hs-cTnT levels.

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Association of Thrombolysis in Myocardial Infarction (TIMI) Risk Score with Angiographic Severity of Coronary Artery Disease In Patients with Non-ST Elevation Acute Coronary Syndrome

University Heart Journal ◽

10.3329/uhj.v15i2.42649 ◽

2019 ◽

Vol 15 (2) ◽

pp. 68-73

Author(s):

ABK Bashiruddin ◽

Mohammad Ibrahim Chowdhury ◽

Biplob Bhattacharjee ◽

Abul Hossen Shahin ◽

Syed Ali Ahsan ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

High Risk ◽

Risk Score ◽

Gensini Score ◽

Coronary Syndrome ◽

Timi Score ◽

Artery Disease ◽

Timi Risk Score

Background: Clinical guidelines recommend that optimal management of acute coronary syndrome (ACS) should include patient risk stratification. Predicting the anatomical extension of coronary artery disease (CAD) is also potentially useful for clinical decision. Objective: The objective of our study was to determine whether the TIMI risk score correlates with the angiographic extent and severity of CAD in patients with NSTE- ACS. Materials and Methods: This was a cross-sectional observational study carried out in the Department of Cardiology, Chattogram Medical College Hospital (CMCH) from September 2017 to May 2018. A total of 200 patients diagnosed with NSTE- Acute Coronary Syndrome were included as sample by purposive sampling method. TIMI risk score for each patient was calculated and the patients were stratified into 3 groups according to the TIMI risk score: low risk (0-2); intermediate risk (3-4); high risk (5-7). The severity of the CAD was assessed by Vessel score and Gensini score. Result: The mean ± SD of the age of study population was 53.7 ±10.8 years (range 37–77) and 142 (71%) were male. Regarding cardiovascular risk factors, 137 (68.5%) patients had diabetes mellitus, 83 (41.5%) had dyslipidaemia, 155 (77.5%) had hypertension, 136 (68%) were current smoker and 70 (35%) had a family history of CAD. The Gensini score was higher in patients at high risk TIMI group (p<0.001). Moreover, there was a signiûcant positive correlation between the TIMI and Gensini score (r=0.446,p<0.001). TIMI score can predict significant CAD moderately well (area under the curve 0.661, p=0.001). Patients with TIMI score > 4 were more likely to have significant three vessel CAD (65.9%) versus those with TIMI risk score 3-4 (17.9%) and TIMI risk score < 3 (2%) (p< 0.001). Conclusion: Study showed the TIMI score is significantly correlated with the extent of CAD as assessed by the Gensini score. It is accurate for predicting severe CAD among NSTE-ACS patients. University Heart Journal Vol. 15, No. 2, Jul 2019; 68-73

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The relationship between the GRACE risk score and the severity of coronary artery disease in patients with non-ST elevated acute coronary syndrome

Abant Medical Journal ◽

10.5505/abantmedj.2015.48344 ◽

2015 ◽

Vol 4 (3) ◽

pp. 216-221

Author(s):

Adem Bekler ◽

Gökhan Erbağ ◽

Hacer Şen ◽

Muhammed Turgut, Alper Özkan ◽

Ali Ümit Yener ◽

...

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Risk Score ◽

Coronary Syndrome ◽

Grace Risk Score ◽

Artery Disease ◽

The Relationship

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CORRELATION OF TIMI RISK SCORE WITH ANGIOGRAPHIC SEVERITY IN PREDICING THE EXTENT OF CORONARY ARTERY DISEASE IN PATIENTS WITH NON ST ELEVATION ACUTE CORONARY SYNDROME

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2015/953 ◽

2015 ◽

Vol 2 (41) ◽

pp. 6981-6991

Author(s):

Senthil N ◽

Ramakrishnan S R ◽

Damodharan J

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Risk Score ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

Artery Disease ◽

Timi Risk Score

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Imaging Patients with Chest Pain in the Emergency Department

10.1093/med/9780199392094.003.0019 ◽

2015 ◽

Author(s):

Prem Soman ◽

James E. Udelson

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Chest Pain ◽

Cardiac Ischemia ◽

Unique Challenge ◽

Malpractice Litigation ◽

Coronary Syndrome ◽

Artery Disease ◽

Pain Patients ◽

The U.S

The six-to-eight million people who present to emergency departments (EDs) across the U.S. each year for the evaluation of chest pain present a unique challenge to physicians.(1) Less than a third of these patients are eventually diagnosed with coronary artery disease (CAD).(2,3) However, a small percentage of patients with acute cardiac ischemia and an acute coronary syndrome (ACS) are inadvertently discharged, with potential adverse consequences.(2,4-6) Concerns about patient safety and malpractice litigation has resulted in the adoption of a practice paradigm that involves observation and testing that is associated with high cost. In this chapter we review the current approaches to risk stratification of chest pain patients, the utility of myocardial perfusion imaging for this purpose and, the ongoing investigation of potential new approaches in this area.

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