scholarly journals Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Evan J. Wiens ◽  
Jorden Arbour ◽  
Kristjan Thompson ◽  
Colette M. Seifer
Keyword(s):  
Emergency Department ◽  
Creatine Kinase ◽  
Acute Coronary Syndromes ◽  
Clinical Utility ◽  
Coronary Syndromes

scholarly journals Biomarkers for Predicting Serious Cardiac Outcomes at 72 Hours in Patients Presenting Early after Chest Pain Onset with Symptoms of Acute Coronary Syndromes

2012 ◽  
Vol 58 (1) ◽  
pp. 298-302 ◽  
Author(s):  
Peter A Kavsak ◽  
Stephen A Hill ◽  
Wendy Bhanich Supapol ◽  
Philip J Devereaux ◽  
Andrew Worster
Keyword(s):  
Emergency Department ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Roc Curve ◽  
Cardiac Troponin ◽  
Acute Coronary Syndromes ◽  
Troponin I ◽  
Diagnostic Sensitivity ◽  
Cardiac Outcomes ◽  
Coronary Syndromes

Abstract BACKGROUND Most outcome studies of patients presenting early to the emergency department with potential acute coronary syndromes have focused on either the index diagnosis of myocardial infarction (MI) or a composite end point at a later time frame (30 days or 1 year). We investigated the performance of 9 biomarkers for an early serious outcome. METHODS Patients (n = 186) who presented to the emergency department within 6 h of chest pain onset had their presentation serum sample measured for the following analytes: creatine kinase, creatine kinase isoenzyme MB, enhanced AccuTnI troponin I (Beckman Coulter), high-sensitivity cardiac troponin T (hs-cTnT), ischemia-modified albumin, interleukin-6, investigation use only hs-cTnI (Beckman Coulter), N-terminal pro–B-type natriuretic peptide, and cardiac troponin I (Abbott AxSym). We followed patients until 72 h after presentation and determined whether they experienced the following serious cardiac outcomes: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death. ROC curves were analyzed to determine the area under the ROC curve (AUC) and optimal cutoffs for the biomarkers. RESULTS The AUCs for the hs-cTnI assay (0.86; 95% CI, 0.76–0.96), the AccuTnI assay (0.86; 95% CI, 0.78–0.95), and the hs-cTnT assay (0.82; 95% CI, 0.71–0.94) assays were significantly higher than those for the other 6 assays (AUC values ≤0.71 for the rest of the biomarkers, P < 0.05). The ROC curve–derived optimal cutoffs were ≥19 ng/L (diagnostic sensitivity, 80%; specificity, 88%), ≥0.018 μg/L (diagnostic sensitivity, 75%; specificity, 86%), and ≥32 ng/L (diagnostic sensitivity, 68%; specificity, 92%) for the hs-cTnI, AccuTnI, and hs-cTnT assays, respectively. CONCLUSIONS The optimal cutoffs for predicting serious cardiac outcomes in this low-risk population are different from the published 99th percentiles. Larger studies are required to verify these findings.

The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting

2007 ◽  
Vol 49 (2) ◽  
pp. 145-152.e1 ◽  
Author(s):  
Jin H. Han ◽  
Christopher J. Lindsell ◽  
Alan B. Storrow ◽  
Samuel Luber ◽  
James W. Hoekstra ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Acute Coronary Syndromes ◽  
Cardiac Risk ◽  
Cardiac Risk Factor ◽  
Emergency Department Setting ◽  
Coronary Syndromes ◽  
Risk Factor Burden

scholarly journals Impact of comorbidities by age on symptom presentation for suspected acute coronary syndromes in the emergency department

2017 ◽  
Vol 16 (6) ◽  
pp. 511-521 ◽  
Author(s):  
Larisa A Burke ◽  
Anne G Rosenfeld ◽  
Mohamud R Daya ◽  
Karen M Vuckovic ◽  
Jessica K Zegre-Hemsey ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndromes ◽  
Symptom Presentation ◽  
Coronary Syndromes

Standardized reporting guidelines for studies evaluating risk stratification of emergency department patients with potential acute coronary syndromes

2004 ◽  
Vol 44 (6) ◽  
pp. 589-598 ◽  
Author(s):  
Multidisciplinary Standardized Re ◽  
Judd E. Hollander ◽  
Andra L. Blomkalns ◽  
Gerard X. Brogan ◽  
Deborah B. Diercks ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Acute Coronary Syndromes ◽  
Reporting Guidelines ◽  
Standardized Reporting ◽  
Coronary Syndromes ◽  
Emergency Department Patients

scholarly journals Underutilization of acetylsalicylic acid for acute coronary syndromes in the emergency department

CJEM ◽  
2004 ◽  
Vol 6 (05) ◽  
pp. 333-336 ◽  
Author(s):  
François Dufresne ◽  
Danielle Blouin ◽  
Xiaoqing Xue ◽  
Marc Afilalo
Keyword(s):  
Emergency Department ◽  
Acetylsalicylic Acid ◽  
Acute Coronary Syndromes ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Final Diagnosis ◽  
Lower Probability ◽  
Cost Effective Treatment ◽  
Coronary Syndromes

ABSTRACT Objective: Acetylsalicylic acid (ASA) is a simple and cost-effective treatment for acute coronary syndromes (ACS). Our objectives were to determine the frequency of ASA administration in the emergency department (ED) for patients with acute myocardial infarction or unstable angina, and to identify patient characteristics associated with its administration. Methods: This is a retrospective chart review of patients discharged with a final diagnosis of ACS. Data on age, gender, mode of presentation, presence of chest pain at triage, administration of ASA or not in the ED, dosage and form of ASA received, timing of administration, presence of contraindications to ASA and use of regular ASA prior to ED presentation were recorded. Results: Six hundred and one charts were analyzed. Five hundred and fifty patients (91.5%) received ASA. Only 444 (73.9%) of these 550 patients were administered the ASA appropriately, according to the American Heart Association / American College of Cardiology (AHA/ACC) guidelines. Univariate analysis showed that chart notes “Transport by ambulance,” “Allergy to ASA” and “Gastrointestinal bleed” were associated with a lower probability of the patient being administered ASA. If a patient was noted as taking ASA regularly, it increased the chance of this patient being administered ASA in the ED. Conclusion: Although the study ED performed well, administering ASA to 91.5% of patients with ACS, only 73.9% of the patients who received ASA were administered the ASA appropriately, as recommended in the AHA/ACC guidelines. Educational strategies and system changes are necessary to increase the proportion of eligible ACS patients who receive appropriate ASA therapy.

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