Complement component 7 is associated with total- and cardiac death in chest-pain patients with suspected acute coronary syndrome

Abstract Background Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. Aim To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. Methods Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. Results At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07–1.47) and cardiac death [HR 1.28 (95% CI 1.02–1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. Conclusions CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS. Clinical trial registration ClinicalTrials.gov Identifier: NCT01377402, NCT00521976.

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Angiopoietin-like 4 protein is a long-term predictor of outcome in chest-pain patients with suspected acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1612 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Aarsetoey ◽

T Ueland ◽

P Aukrust ◽

A.E Michelsen ◽

V Ponitz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Subgroup Analysis ◽

Cardiac Death ◽

Funding Source ◽

Long Term Outcome ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Pain Patients

Abstract Introduction Angiopoietin-like 4 protein (ANGPTL4) has multiple physiological functions including modulation of angiogenesis, vascular permeability and lipid-metabolism. Acting as an inhibitor of lipoprotein lipase, ANGPTL4 has previously been found to be associated with lipid levels and risk of coronary artery disease. Purpose To assess the prognostic value of ANGPTL4 for long-term outcome, in addition to conventional clinical risk factors, in chest-pain patients admitted with clinically suspected acute coronary syndrome (ACS). Methods 1853 patients from Norway and Northern-Argentina were consecutively included in this prospective 2-center cohort study. ANGPTL4 concentrations were measured in 1829 admission-samples by enzyme immunoassay. Data were pooled for analysis. Multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24-months, comparing event rates across ANGPTL4-quartiles (Q1–4). Of patients with suspected ACS, 845 had a troponin T (TnT) value above the detection-limit. Subgroup analysis was performed for all-cause mortality in patients stratified according to TnT release >/≤0.01 ng/mL. Results During 24-months follow-up, 254 patients (13.9%) died, of which 150 (8.2%) suffered cardiac death and 76 (4.2%) SCD. Patients who died had significantly higher admission-levels of ANGPTL4 compared to long-term survivors [4.99 (3.54–8.37) ng/mL versus 3.18 (2.14–4.78) ng/mL (median, 25 and 75% percentiles), p<0.001]. A stepwise increase in risk of all-cause death was seen with increasing quartiles of ANGPTL4, Figure 1. For cardiac death, ANGPTL4-levels in Q4 [Hazard Ratio (HR) 2.86 (95% confidence interval (CI); 1.10–7.45), p=0.031] as compared to Q1 were found to be an independent predictor of outcome. Similar results were seen for SCD in adjusted analysis for ANGPTL4-Q4 [HR 7.37 (95% CI: 1.75–31.1), p=0.007] as compared to Q1. In subgroup analysis, ANGPTL4 concentrations in the highest quartile were significantly associated with increased risk of all-cause mortality in patients with TnT-release [HR 2.07 (95% CI: 1.06–4.02), p=0.032], but not in patients without TnT-release. Conclusion High admission-levels of ANGPTL4 were found to be an independent long-term predictor of all-cause mortality, cardiac death and SCD in patients with suspected ACS. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority

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Complement component-7 is a long-term predictor of all-cause mortality in chest-pain patients with suspected acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1610 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Aarsetoey ◽

T Ueland ◽

P Aukrust ◽

A.E Michelsen ◽

V Ponitz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Death ◽

Funding Source ◽

Coronary Syndrome ◽

Western Norway ◽

Increased Risk ◽

All Cause Mortality ◽

Pain Patients

Abstract Introduction The complement cascade is an important component of the innate immune system. Complement activation plays a major role in chronic inflammation and has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (C7) binds C5bC6 complex being part of the terminal complement complex (TCC/C5b-9). Purpose To investigate the prognostic utility of complement C7 for long-term outcome in patients with suspected acute coronary syndrome (ACS). Methods Complement C7 plasma-levels were measured by enzyme immunoassay in admission samples from 1823 patients included in a transatlantic prospective cohort study, which consecutively included hospital admitted chest-pain patients with clinically suspected ACS from South-Western Norway and Northern Argentina. Data were pooled for analysis. Univariable- and multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24 months, applying both quartiles (Q1–4) and loge-transformed continuous values of complement C7. Results There were 253 (13.9%) deaths, of which 150 (8.2%) were categorized as cardiac death and 76 (4.2%) as SCD. Complement C7 levels were significantly higher in patients who died as compared to long-term survivors [176.9 (142.1–228.7) μg/mL versus 139.8 (110.6–179.7) μg/mL (median, 25 and 75% percentile), p<0.001], and were significantly associated with 24-month survival [log rank p<0.001 for all-cause mortality and cardiac death, log rank p=0.035 for SCD]. In univariable analysis, patients with complement C7-concentrations in the highest quartiles had significantly increased risk of all-cause mortality (Figure 1), cardiac death [Q4: Hazard Ratio (HR) 4.58 (95% confidence interval (CI): 2.65–7.92), p<0.001, Q3: HR 2.69 (95% CI: 1.51–4.80), p=0.001] and SCD [Q4: HR 2.83 (95% CI: 1.36–5.90), p=0.005, Q3: HR 2.33 (95% CI: 1.10–4.92), p=0.027] compared to patients in the lowest quartile (Q1). After adjusting for conventional clinical risk factors for coronary heart disease, complement C7-concentrations in Q4 [HR 2.09 (95% CI: 1.23–3.57), p=0.007] and Q3 [HR 2.21 (95% CI: 1.29–3.81), p=0.004] remained significantly associated with all-cause mortality, reproduced using loge-transformed continuous values. Conclusion High levels of complement C7 were found to independently predict long-term all-cause mortality in chest-pain patients with clinically suspected ACS. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority

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Angiopoietin-2 is a long-term predictor of all-cause mortality, cardiac death and sudden cardiac death in chest-pain patients with suspected acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1659 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Aarsetoey ◽

T Ueland ◽

P Aukrust ◽

A.E Michelsen ◽

V Ponitz ◽

...

Keyword(s):

Chest Pain ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Funding Source ◽

Coronary Syndrome ◽

All Cause Mortality ◽

Angiopoietin 2 ◽

Pain Patients

Abstract Background Angiopoietin-2 (ANGPT2) is an important regulator of angiogenesis. Higher levels of ANGPT2 have been found to be associated with an adverse cardiovascular risk factor profile potentially reflecting maladaptive vascular remodelling including atherosclerotic plaque destabilization. Purpose To evaluate the prognostic utility of ANGPT2 added to conventional clinical risk factors for coronary heart disease, including B-type natriuretic peptide (BNP), troponin T (TnT) and C-reactive protein (CRP), in patients with suspected acute coronary syndrome (ACS). Methods 871 chest-pain patients with clinically suspected ACS from South-Western Norway and 982 patients from Northern Argentina were consecutively included in a prospective transatlantic cohort study. We measured plasma-concentrations of ANGPT2 in admission-samples from 1815 patients by enzyme immunoassay. Univariable- and multivariable Cox proportional-hazards models, applying both loge-transformed continuous values and quartiles (Q1–4), were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24-month follow-up. Of the patients with suspected ACS, 838 patients had TnT release above the detection-limit of 0.01 ng/mL. We performed subgroup analysis for all-cause mortality in patients with and without TnT release. Results Median age in the total population was 66.0 (Q1-Q3; 55.0–76.8) years and 60.4% were males. At 24-month follow-up, 254 patients (14%) had died, of which 150 (8.3%) suffered cardiac death and 76 (4.2%) SCD. ANGPT2 levels were significantly higher in patients who died compared to long-term survivors [3.87 (2.40–7.54) ng/mL versus 2.11 (1.48–3.22) ng/mL (median, 25 and 75% percentiles), p<0.001]. In multivariable analysis, ANGPT2 concentrations in the highest quartile (Q4) as compared to the lowest (Q1) were significantly associated with all-cause mortality [Hazard Ratio (HR) 1.96 (95% confidence interval (CI); 1.12–3.42), p=0.018) and cardiac death [HR 2.23 (95% CI; 1.01–4.92), p=0.047] at 24-month follow-up. For SCD, ANGPT2 concentrations in both Q3 [HR 3.59 (95% CI; 1.05–12.3), p=0.041] and Q4 [HR 3.81 (95% CI; 1.12–12.9), p=0.032] as compared to Q1 were significantly related to outcome. These results were confirmed using loge-transformed continuous values of ANGPT2. ANGPT2 was also an independent predictor of all-cause mortality in both patients with and without TnT release. For patients with TnT >0.01 ng/mL, HR for ANGPT2 in Q4 as compared to Q1 was 2.77 (95% CI: 1.41–5.44), p=0.003. For patients with TnT ≤0.01, HR for ANGPT2-Q4 was 2.67 (95% CI: 1.08–6.62), p=0.034. Conclusion High levels of ANGPT2 were found to independently predict all-cause mortality, cardiac death and sudden cardiac death in chest-pain patients with suspected ACS, irrespective of clinical demographics, troponin-release, CRP and BNP. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority

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Abstract P069: Prognostic Impact of the Omega-3 Index in Chest Pain Patients With a Suspected Acute Coronary Syndrome and Low Dietary Intake of Omega-3

Circulation ◽

10.1161/circ.125.suppl_10.ap069 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Ricardo A Leon de la Fuente ◽

Patrycja A Naesgaard ◽

Stein Tore Nilsen ◽

Torbjoern Aarsland ◽

Leik Woie ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Death ◽

Smoking History ◽

Dietary Habit ◽

Prognostic Impact ◽

Omega 3 ◽

Cox Regression Analysis ◽

Coronary Syndrome

Background: Epidemiological and interventional studies suggest that omega-3 (n-3) fatty acids derived from fish oil can reduce the occurrence of cardiovascular disease. Based on these observations, the omega-3 index [eicosapantaenoic acid (EPA) + docosahexaenoic acid (DHA) content in cell red blood membranes] has been suggested as a novel risk marker for cardiac death. Objective: To assess whether the omega-3 index can predict all-cause mortality, cardiac death and sudden cardiac death (SCD) following hospitalization with an acute coronary syndrome (ACS). Material and methods: The omega-3 index was measured in 572 consecutive patients admitted with chest pain and suspected ACS in an inland Northern Argentinean city with a dietary habit essentially based on red meat and a low intake of fish. The median age of the included patients was 63 years and 59 % were males. Clinical endpoints were collected during a 5-year follow-up period, median 3.64 years, range 1 day to 5.46 years. Stepwise Cox regression analysis was employed to compare the rate of new events in the quartiles of the omega-3 index measured at inclusion. In our multivariable analysis we corrected for age, sex, arterial hypertension, diabetes, smoking history, body mass index, previous coronary heart disease, high-sensitivity C-reactive protein, brain natriuretic peptide, Troponin-T release and use of statins and beta-blockers. Results: No statistical significant differences in baseline characteristics were noted between quartiles of the omega-3 index. The median omega 3-index was 2.8%, and ranging from 1.9% in the lowest to 3.8% in the highest quartile. During the follow-up period, 100 (17.5%) patients died. Event rates were similar in all quartiles of the omega-3 index, with no statistical significant differences. Conclusions: In a population with a low intake of fish and fish oils, the omega-3 index did not predict future fatal events in patients with acute chest pain and suspected ACS, suggesting that index levels less than 4% are too low to be protective.

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P3613J-shaped relationship between cardiac mortality risk and admission systolic blood pressure in patients aged 65 years and over with acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz745.0472 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Y Jiang ◽

H W Li

Keyword(s):

Blood Pressure ◽

Acute Coronary Syndrome ◽

Systolic Blood Pressure ◽

Cardiac Death ◽

Cardiac Mortality ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality

Abstract Objective To observe the effects of different admission systolic blood pressure (SBP) levels on the in-hospital and long-term prognosis of elderly patients with acute coronary syndrome (ACS). Methods This retrospective cohort study included 5812 ACS patients aged 65 and over admitted from January, 2013 to September, 2018. Their blood pressure, medical history and laboratory examinations were recorded. The patients were divided into 5 groups according to the level of admission SBP (<100, 100–119, 120–139, 140–159, and ≥160 mmHg). The main endpoint of this study was cardiac death and all-cause death in hospital and during 6-year follow-up. Results Among the participants, the number of patients admitted with SBP <100, 100–119, 120–139, 140–159, and ≥160 mmHg were 143 (2.5%), 1014 (17.4%), 2456 (42.3%), 1607 (27.6%), and 592 (10.2%), respectively. The highest in-hospital cardiac mortality and all-cause mortality rate were found in the group with admission SBP <100 mmHg and the lowest were found in the group with SBP 140–159 mmHg (9.1% vs. 3.2% vs. 1.1% vs. 0.8% vs. 1.5%, P=0.000; 9.8% vs. 3.4% vs. 1.1% vs. 0.8% vs. 1.7%, P=0.000). Kaplan-Meier curve showed that patients with SBP 120–139 mmHg at admission had better prognosis (cardiac mortality: 3.9% vs. 10.9%, 5.6%, 5.1%, and 6.7% respectively, P=0.000; all-cause mortality: 7.6% vs. 14.7%, 9.7%, 9.1%, and 11.0%, respectively, P=0.000). Multivariate analysis showed that admission SBP <120 mmHg or ≥160 mmHg was a independent predictors of follow-up cardiac death (HR 1.747, 95% CI 1.066–2.861, P=0.027; HR 1.496, 95% CI 1.092–2.050, P=0.012; HR 1.630, 95% CI 1.120–2.372, P=0.011) compared with patients admitted with SBP 120–139 mmHg. In-hospital and 6-year follow-up outcomes of ACS patients ≥65y by admission SBP Admission SBP Level <100mmHg ≥100mmHg and <120mmHg ≥120mmHg and <140mmHg ≥140mmHg and <160mmHg ≥160mmHg P In-hospital (n=143) (n=1014) (n=2456) (n=1607) (n=592) Cardiac mortality, n (%) 13 (9.1) 32 (3.2) 28 (1.1) 13 (0.8) 9 (1.5) 0.000 All-cause mortality, n (%) 14 (9.8) 34 (3.4) 28 (1.1) 13 (0.8) 10 (1.7) 0.000 Follow-up (n=129) (n=980) (n=2428) (n=1594) (n=582) Cardiac mortality, n (%) 14 (10.9) 55 (5.6) 94 (3.9) 81 (5.1) 39 (6.7) 0.000 All-cause mortality, n (%) 19 (14.7) 95 (9.7) 185 (7.6) 144 (9.1) 64 (11.0) 0.000 Kaplan-Meier analyses Conclusion In ACS patients ≥65 y, a “J” relationship between admission SBP and cardiac mortality is observed. For ACS patients aged 65 years and over, admission SBP <120 mmHg or ≥160mmHg is a independent risk factor for long-term cardiac death. Acknowledgement/Funding National Natural Science Foundation of China (No. 81300333))

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Macrophage infiltrates in coronary plaque erosion portend a worse cardiovascular outcome in patients with acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1250 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R.A Montone ◽

V Vetrugno ◽

M Camilli ◽

M Russo ◽

M.G Del Buono ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Vulnerable Plaque ◽

Cardiac Death ◽

Cox Regression ◽

Plaque Rupture ◽

Culprit Lesion ◽

Coronary Syndrome ◽

Fibrous Cap ◽

Plaque Erosion

Abstract Background Plaque erosion (PE) is responsible for at least one-third of acute coronary syndrome (ACS). Inflammatory activation is considered a key mechanism of plaque instability in patients with plaque rupture through the release of metalloproteinases and the inhibition of collagen synthesis that in turns lead to fibrous cap degradation. However, the clinical relevance of macrophage infiltration has never been investigated in patients with PE. Purpose In our study, we aimed at assessing the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) at the culprit site in ACS patients with PE, evaluating their clinical and OCT correlates, along with their prognostic value. Methods ACS patients undergoing OCT imaging and presenting PE as culprit lesion were retrospectively selected. Presence of MØI at culprit site and in non-culprit segments along the culprit vessel was assessed. The incidence of major adverse cardiac events (MACEs), defined as the composite of cardiac death, recurrent myocardial infarction and target vessel revascularization (TVR), was assessed [follow-up median (interquartile range, IQR) time 2.5 (2.03–2.58) years]. Results We included 153 patients [median age (IQR) 64 (53–75) years, 99 (64.7%) males]. Fifty-one (33.3%) patients presented PE with MØI and 102 (66.7%) PE without MØI. Patients having PE with MØI compared with PE patients without MØI had more vulnerable plaque features both at culprit site and at non-culprit segments. In particular, culprit lesion analysis demonstrated that patients with PE with MØI had a significantly thinner fibrous cap [median (IQR) 100 (60–120) μm vs. 160 (95–190) μm, p<0.001], higher prevalence of thrombus [41 (80.4%) vs. 64 (62.7%), p=0.028], lipid plaque [39 (76.5%) vs. 50 (49.0%), p<0.001], TCFA [20 (39.2%) vs. 14 (13.7%), p=0.001], and a higher maximum lipid arc [median [IQR] 250.0° (177.5°-290.0°) vs. 190.0° (150.0°-260.0°), p=0.018) at the culprit lesion compared with PE without MØI. MACEs were significantly more frequent in PE with MØI patients compared with PE without MØI [11 (21.6%) vs. 6 (5.9%), p=0.008], mainly driven by a higher risk of cardiac death and TVR. At multivariable Cox regression model, PE with MØI [HR=2.95, 95% CI (1.09–8.02), p=0.034] was an independent predictor of MACEs. Conclusion Our study demonstrates that among ACS patients with PE the presence of MØI at culprit lesion is associated with a more aggressive phenotype of coronary atherosclerosis with more vulnerable plaque features, along with a worse prognosis at a long-term follow-up. These findings are of the utmost importance in the era of precision medicine because clearly show that macrophage infiltrates may identify patients with a higher cardiovascular risk requiring more aggressive secondary prevention therapies and a closer clinical follow-up. Prognosis Funding Acknowledgement Type of funding source: None

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Abstract 12162: Association of Symptom Clusters With Mode of Transportation to Emergency Department in Patients Diagnosed With Acute Coronary Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.12162 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Leslie L Davis ◽

Thomas P McCoy ◽

Barbara Riegel ◽

Sharon McKinley ◽

Lynn Doering ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Delay Time ◽

Symptom Clusters ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Stress Symptoms ◽

Mode Of Transportation

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.

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Reliability of the CARE rule and the HEART score to rule out an acute coronary syndrome in non-traumatic chest pain patients

Internal and Emergency Medicine ◽

10.1007/s11739-018-1803-4 ◽

2018 ◽

Vol 13 (7) ◽

pp. 1111-1119 ◽

Cited By ~ 3

Author(s):

Thomas Moumneh ◽

Vanessa Richard-Jourjon ◽

Emilie Friou ◽

Fabrice Prunier ◽

Caroline Soulie-Chavignon ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Heart Score ◽

Coronary Syndrome ◽

Pain Patients ◽

Rule Out

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PP23 Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for chest pain patients. A systematic review abstract

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.23 ◽

2021 ◽

Vol 38 (9) ◽

pp. A10.2-A10

Author(s):

Ahmed Alotaibi ◽

Abdulrhman Alghamdi ◽

Charles Reynard ◽

Richard Body

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Prediction Models ◽

Meta Analysis ◽

Final Diagnosis ◽

Telephone Triage ◽

Coronary Syndrome ◽

Life Threatening ◽

Pain Patients

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

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Abstract 309: Is Right Bundle Branch Block Associated with Poor Outcomes in the Setting of an Acute Coronary Syndrome? A Systematic Review and Meta-analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.309 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Ahmad Hazem ◽

Sunita Sharma ◽

Amit Sharma ◽

Cameron Leitch ◽

Roopalakshmi Sharadanant ◽

...

Keyword(s):

Systematic Review ◽

Acute Coronary Syndrome ◽

Right Bundle Branch Block ◽

Risk Ratio ◽

Meta Analysis ◽

Forest Plot ◽

Bundle Branch Block ◽

Coronary Syndrome ◽

All Cause Mortality

Importance: Up to 10% of patients with acute myocardial infarction (AMI) have right bundle branch block (RBBB), and RBBB has been associated with a higher risk of mortality. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with AMI. Acute coronary syndrome (ACS) Data Sources: We have systematically searched Ovid, Scopus and Web of Science through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts, selecting studies that described all-cause mortality or cardiovascular death in patients with RBBB and suspected ACS. We excluded studies that reported unadjusted outcomes. Knowledge synthesis: We pooled risk ratio with hazard ratio in studies reporting those outcomes. When reported, odds ratio was converted into risk ratio using reported event rate in each study’s unexposed -read: non RBBB- group. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: Eighteen studies were found that reported eligible data. All were observational studies, involving over 89,000 patients. In short-term follow up (up to 30 days), RBBB on presentation was associated with higher all-cause mortality rate, compared to patients without RBBB (RR 2.23, 95% CI 1.76-2.82). There was a trend for higher mortality at long-term follow up (range: 6 months-16 years) that did not reach statistical significance (RR 1.45, 95% CI 0.93-2.25). Figure-1 demonstrates the forest plot. Risk of bias was assessed with the Newcastle-Ottawa scale and majority of included studied were deemed moderate to high quality. Conclusion and Relevance: RBBB is associated with a more than 2-fold higher risk of all-cause mortality in patients with AMI at 30 days follow up. Patients with AMI and RBBB represent a high risk group for adverse outcomes. A sentence on the differential findings for new vs. old RBBB and association with outcomes could follow here.

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