Validation of a high-risk versus low-risk referral model in suspected Acute Coronary Syndrome

Introduction: Chest pain is one of the most common reasons for emergency department (ED) visits in developed countries. Patients discharged after ED assessment remain at risk for adverse cardiac events. Although a volume-outcome relationship has been shown for myocardial infarction, it is uncertain whether a similar relationship exists with ED chest pain volume. Accordingly, we aimed to determine whether ED chest pain volume influences outcomes of patients presenting to the ED with chest pain who were discharged home. Methods: This was a retrospective cohort study using population-based data from Ontario, Canada. Patients who were discharged home from an ED in Ontario with a primary diagnosis of chest pain from April 1, 2004 to March 31, 2010 were included. High-risk patients were defined as the presence of diabetes or pre-existing cardiovascular disease, while low-risk patients were defined as the absence of these conditions. ED volume was categorized as low, medium, or high, based on tertiles of annual chest pain patient volume. The primary outcome of this study was all-cause mortality one year after the index ED visit. Mantel-Haenszel Chi-Square was used to compare crude outcome rates. Results: There were 56,767 high-risk patients. The average age was 66 years and 53% were male. All-cause mortality rates were 6.8%, 6.3%, and 6.0% (p=0.028), and rates of hospitalization for acute coronary syndrome were 5.8%, 4.6%, and 4.0% (p<0.001) among low, medium, and high volume EDs respectively. There were 216,527 low-risk patients. The average age was 64 years and 42% were male. All-cause mortality rates were 2.0%, 1.9%, and 1.6% (p<0.001), and rates of hospitalization for acute coronary syndrome were 1.5%, 1.4%, and 1.0% (p<0.001) among low, medium, and high volume EDs respectively. Conclusion: Higher volume EDs were associated with decreased rates of all-cause mortality and admission for acute coronary syndrome among chest pain patients who were discharged home. Future research should study the reasons for this finding and attempt to improve outcomes in lower volume EDs.

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Diagnostic Yield of Emergent Coronary CT Angiography in Intermediate-to-high-risk Patients for Suspected Acute Coronary Syndrome: Results from an Emergency Department Registry

10.1055/s-0038-1641292 ◽

2018 ◽

Author(s):

J Scholtz ◽

D Addison ◽

D Bittner ◽

S Janjua ◽

B Foldyna ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

High Risk ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Diagnostic Yield ◽

Coronary Syndrome ◽

Coronary Ct ◽

Risk Patients ◽

Emergency Department Registry

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Evaluation of Ambulatory Monitoring of Patients After High-risk Acute Coronary Syndrome Using Two Different Systems: Biomonitor-2 and Kardia Mobile

Case Medical Research ◽

10.31525/ct1-nct03940066 ◽

2019 ◽

Author(s):

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Ambulatory Monitoring ◽

Coronary Syndrome

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Long Term Prognostic Utility of Matrix Metalloproteinase-9 in Patients with Acute Coronary Syndrome – A Systematic Review

Current Pharmaceutical Biotechnology ◽

10.2174/1389201021666200703200736 ◽

2020 ◽

Vol 21 ◽

Author(s):

Anamika Das ◽

Melvin George ◽

Durga Jha ◽

Luxitaa Goenka

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Matrix Metalloproteinase ◽

Developed Countries ◽

Left Ventricular ◽

Original Research ◽

Coronary Syndrome ◽

Potential Biomarker ◽

Prognostic Utility

Background: Acute coronary syndrome (ACS) is the leading cause for morbidity and mortality in developed countries. Numerous groups have explored single and multiple biomarker strategies to identify diagnostic prognosticators of ACS which will improve our ability to identify high-risk individuals. Matrix metalloproteinase (MMP-9) is one potential biomarker which has been widely studied in ACS. Recent reports have showed the prognostic utility of MMP-9, but due to inconsistent results, it has not been possible to draw firm conclusions. Objective: This review aims to explore the ability of MMP-9 to predict long-term prognosis of ACS. To clarify this issue, we conducted a literature review to provide a comprehensive assessment of MMP-9 levels in ACS patients. Method: We retrieved a total of 1501 articles from PubMed and Google Scholar. After thorough scrutiny, 12 original research articles were found fulfilling the inclusion exclusion criteria. MMP-9’s ability as a biomarker of prognostication post ACS was reviewed. PRISMA guidelines were used for reporting. Result: The results revealed that MMP-9, apart from being an efficient diagnostic biomarker for ACS, helps in predicting the future risk of ACS with disease outcome. Positive correlation was found between plasma MMP-9 and left ventricular remodeling. A positive association was also found between cardiovascular death and higher MMP-9 levels. Conclusion: MMP-9 can be a potential prognostic marker for ACS and aid in identifying high risk patients for intensive management during follow -up.

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Patients with Acute Coronary Syndrome are at High Risk Prior to the Event and Lipid Management is Underachieved Pre- and Post- Hospitalization

Current Vascular Pharmacology ◽

10.2174/1570161115666170621120529 ◽

2018 ◽

Vol 16 (4) ◽

pp. 405-413 ◽

Cited By ~ 2

Author(s):

C. Vlachopoulos ◽

G. Andrikopoulos ◽

D. Terentes-Printzios ◽

S. Tzeis ◽

E. K. Iliodromitis ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Lipid Management ◽

Coronary Syndrome

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The effect of obstructive sleep apnoea on timing of acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1363 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.H Muhmad Hamidi ◽

H Sani ◽

M.A Ibrahim ◽

K.S Ibrahim ◽

A.B Md Radzi ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Systolic Function ◽

Strong Association ◽

Multiple Logistic Regression Analysis ◽

Sleep Apnoea ◽

Neck Circumference ◽

Coronary Syndrome ◽

Obstructive Sleep ◽

Significant Difference

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

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