Medical history of coronary artery disease and time to electrocardiogram in the emergency department: a real-life, single-center, retrospective analysis

Abstract Background Timely acquisition of 12-lead Electrocardiogram (ECG) in the emergency department (ED) is crucial and recommended by current guidelines. Objectives To evaluate the association of medical history of coronary artery disease (hCAD) on door-to-ECG time in the ED. Methods In this single center, retrospective cohort study, patients admitted to ED for cardiac evaluation were grouped according to hCAD and no hCAD. The primary outcome was door-to-ECG time. A multivariate analysis adjusted for the cofounders sex, age, type of referral and shift was performed to evaluate the association of hCAD with door-to-ECG time. Results 1101 patients were included in this analysis. 362 patients (33%) had hCAD. Patients with hCAD had shorter door-to-ECG time (20 min. [Inter Quartile Range [IQR] 13–30] vs. 22 min. [IQR 14–37]; p < 0.001) when compared to patients with no hCAD. In a multivariable regression analysis hCAD was significantly associated with a shorter door-to-ECG time (− 3 min [p = 0.007; 95% confidence Interval [CI] − 5.16 to − 0.84 min]). Conclusion In this single center registry, hCAD was associated with shorter door-to-ECG time. In patients presenting in ED for cardiac evaluation, timely ECG diagnostic should be facilitated irrespective of hCAD.

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Medical History of Coronary Artery Disease and Time to Electrocardiogram in the Emergency Department: A Real-Life, Single-Center, Retrospective Analysis

10.21203/rs.3.rs-654377/v1 ◽

2021 ◽

Author(s):

Lukas Andreas Heger ◽

Tina Glück ◽

Klaus Kaier ◽

Marcus Hortmann ◽

Marina Rieder ◽

...

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Coronary Artery ◽

Medical History ◽

Real Life ◽

Single Center ◽

Cardiac Evaluation ◽

History Of ◽

Multivariable Regression ◽

Artery Disease

Abstract Background: Timely acquisition of 12-lead Electrocardiogram (ECG) in the emergency department (ED) is crucial and recommended by current guidelines. Objectives: To evaluate the association of medical history of coronary artery disease (hCAD) on door-to-ECG time in the ED.Methods: In this single center, retrospective cohort study, patients admitted to ED for cardiac evaluation between were grouped according to hCAD, and no hCAD. The primary outcome was door-to-ECG time. A multivariate analysis adjusted for the cofounders sex, age, type of referral and shift was performed to evaluate the association of hCAD with door-to-ECG.Results: 1,101 patients were included in this analysis. 362 patients (33%) had hCAD. Patients with hCAD had shorter door-to-ECG time (20 min. [Inter Quartile Range [IQR] 13 – 30] vs. 22 min. [IQR 14 – 37]; p<0.001) when compared to patients with no hCAD. In a multivariable regression analysis hCAD was significantly associated with a shorter door-to-ECG time (- 3 min. [p=0.007; 95% confidence Interval [CI] -5.16 – -0.84 min.]). Conclusion: In this single center registry, hCAD was associated with shorter door-to-ECG time. In patients presenting in ED for cardiac evaluation, timely ECG diagnostic should be facilitated irrespective of hCAD.

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Echocardiographic wall motion abnormalities in patients with stroke may warrant cardiac evaluation

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-320219 ◽

2019 ◽

Vol 90 (7) ◽

pp. 792-795

Author(s):

Shadi Yaghi ◽

Andrew D Chang ◽

Brittany A Ricci ◽

Brian MacGrory ◽

Shawna Cutting ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Ischaemic Stroke ◽

Wall Motion ◽

Cardiac Evaluation ◽

History Of ◽

Wall Motion Abnormalities ◽

Artery Disease

BackgroundThe aetiology of wall motion abnormalities (WMA) in patients with ischaemic stroke is unclear. We hypothesised that WMAs on transthoracic echocardiography (TTE) in the setting of ischaemic stroke mostly reflect pre-existing coronary heart disease rather than simply an isolated neurocardiogenic phenomenon.MethodsData were retrospectively abstracted from a prospective ischaemic stroke database over 18 months and included patients with ischaemic stroke who underwent a TTE. Coronary artery disease was defined as history of myocardial infarction (MI), coronary intervention or ECG evidence of prior MI. The presence (vs absence) of WMA was abstracted. Multivariable logistic regression was used to determine the association between coronary artery disease and WMA in models adjusting for potential confounders.ResultsWe identified 1044 patients who met inclusion criteria; 139 (13.3%, 95% CI 11.2% to 15.4%) had evidence of WMA of whom only 23 (16.6%, 95% CI 10.4% to 22.8%) had no history of heart disease or ECG evidence of prior MI. Among these 23 patients, 12 had a follow-up TTE after the stroke and WMA persisted in 92.7% (11/12) of patients. In fully adjusted models, factors associated with WMA were older age (OR per year increase 1.03, 95% 1.01 to 1.05, p=0.009), congestive heart failure (OR 4.44, 95% CI 2.39 to 8.33, p<0.001), history of coronary heart disease or ECG evidence prior MI (OR 27.03, 95% CI 14.93 to 50.0, p<0.001) and elevated serum troponin levels (OR 2.00, 95% CI 1.06 to 3.75, p=0.031).ConclusionIn patients with ischaemic stroke, WMA on TTE may reflect underlying cardiac disease and further cardiac evaluation may be considered.

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Treadmill Exercise Stress Echocardiography in Patients With No History of Coronary Artery Disease: A Single-Center Experience in Korean Population

Korean Circulation Journal ◽

10.4070/kcj.2011.41.9.528 ◽

2011 ◽

Vol 41 (9) ◽

pp. 528 ◽

Cited By ~ 5

Author(s):

Jeong Yoon Jang ◽

Il Suk Sohn ◽

Jong Nim Kim ◽

Jeong Hwan Park ◽

Chang Bum Park ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stress Echocardiography ◽

Treadmill Exercise ◽

Exercise Stress ◽

Korean Population ◽

Single Center ◽

Single Center Experience ◽

History Of ◽

Artery Disease

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Emergency Department Visits and Subsequent Hospital Admission Trends for Patients with Chest Pain and a History of Coronary Artery Disease

Cardiology and Therapy ◽

10.1007/s40119-020-00168-5 ◽

2020 ◽

Vol 9 (1) ◽

pp. 153-165 ◽

Cited By ~ 1

Author(s):

Christine Eichelberger ◽

Aarti Patel ◽

Zhijie Ding ◽

Christopher D. Pericone ◽

Jennifer H. Lin ◽

...

Keyword(s):

Coronary Artery Disease ◽

Emergency Department ◽

Chest Pain ◽

Coronary Artery ◽

Hospital Admission ◽

Emergency Department Visits ◽

History Of ◽

Artery Disease

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Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

Journal of Clinical Medicine ◽

10.3390/jcm9082367 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2367 ◽

Cited By ~ 1

Author(s):

Sandro Ninni ◽

Gilles Lemesle ◽

Thibaud Meurice ◽

Olivier Tricot ◽

Nicolas Lamblin ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Real Life ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Outpatient Visits ◽

History Of ◽

Artery Disease

Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.

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