An Italian registry of chest pain patients in the emergency department: clinical predictors of acute coronary syndrome

Ballarino, Paola; Cervellin, Gianfranco; Trucchi, Cecilia; Altomonte, F; Bertini, A; Bonfanti, Laura; Bressan, Maria Antonietta; Carpinteri, Giuseppe; Noto, Paola; Gavelli, Francesco; Molinari, Luca; Patrucco, Filippo; Sainaghi, Pier Paolo; Caristia, Silvia; Cavazza, Mario; Gargiulo, Mauro; Longo, Stefania; Cremonesi, Paolo; Orsi, Andrea; Ansaldi, Filippo; Marino, Rossella; Somma, Salvatore Di; Castello, Luigi Mario; Moscatelli, P; Avanzi, Gian Carlo

doi:10.23736/s0026-4806.20.06472-1

Cited by 15 publications

(6 citation statements)

References 49 publications

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“…With older age, cardiac chest pain is more common, with a subsequent decrease in the prevalence of NCCP. Chest pain is a common presentation to emergency departments [69], although only 25% of individuals who experience this symptom present to a hospital [70]. Beyond GERD (30-60% of cases), other esophageal causes of NCCP are esophageal dysmotility (15-30%) and esophageal hypersensitivity [68,69,71], alone or in combination.…”

Section: Chest Painmentioning

confidence: 99%

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Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Durazzo

Lupi

Cicerchia

et al. 2020

JCM

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Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss extra-esophageal manifestations of GERD, focusing on clinical presentations, diagnosis, and treatment. Common extra-esophageal manifestations of GERD include chronic cough, asthma, laryngitis, dental erosions, and gingivitis. Extra-esophageal involvement can be present also when classic GERD symptoms are absent, making the diagnosis more challenging. Although available clinical studies are heterogeneous and frequently of low quality, a trial with proton pump inhibitors can be suggested as a first-line diagnostic strategy in case of suspected extra-esophageal manifestations of GERD.

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Section: Chest Painmentioning

confidence: 99%

Section: Chest Painmentioning

confidence: 99%

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Durazzo

Lupi

Cicerchia

et al. 2020

JCM

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“…This study has several limitations. First, the exclusion of patients arriving by ambulance lead to a low rate of STEMI patients in the study (9,4% of the ACS group), considerably lower than what is observed in other studies (27-30% of the ACS group) [21,22]. A higher rate of STEMI patients would have led de facto to a higher specificity of an ECG-based triage system.…”

Section: Discussionmentioning

confidence: 64%

Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram

et al. 2022

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Background The triage of patients presenting with chest pain on admission to the emergency department uses scales based on patient clinical presentation or an electrocardiogram (ECG). These scales have different sensitivity and specificity. Although a good sensitivity allows for the prompt identification of high-risk patients, specificity prevent ED overcrowding. Moreover, ECG at triage avoids missing ST elevation myocardial infarction, which requires urgent revascularization. Our study therefore aimed to investigate whether a scale combining ECG and cardiovascular risk factors (CVRF) improves the diagnostic performance of ED chest pain triage scale. Methods and results In this prospective single-center observational study involving 505 patients, the standard ECG-based FRENCH scale was compared to a scale combining the ECG-based FRENCH scale and the patients CVRF. The new scale was called the “modified” FRENCH. The accuracy of patient CVRF collection was evaluated by comparing the results of triage nurses and ED physicians. Compared with the standard FRENCH scale, the modified FRENCH scale had an increased sensitivity (61% versus 75%) but a decrease in specificity (76% versus 64%) resulting in a similar diagnostic performance. Using CVRF collected by the ED physicians, the modified FRENCH scale had a sensitivity of 87% and a specificity of 56% with a significant improvement in his diagnostic performance compared with standard FRENCH scales. This improvement can be explained by an accurate collection of the CVRF by physicians compared with nurses, as suggested by the weak to moderate correlation between their respective data collection. Conclusion In conclusion, combining ECG and accurately collected cardiovascular risks factor improves the diagnostic performance of the ECG based chest pain triage in the ED. Trial registration Trial registration number: NCT03913767.

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“…In the literature, two studies also showed that the set of clinical-instrumental variables had the best capabilities of predicting an ACS diagnosis, although no data regarding cTn were reported [26,27]. On the other hand, other studies aimed to evaluate which factors were associated with an increase in hs-cTnT value and for this reason they differ from ours [28,29].…”

Section: Discussionmentioning

confidence: 96%

High-Sensitivity Cardiac Troponin T and the Diagnosis of Cardiovascular Disease in the Emergency Room: The Importance of Combining Cardiovascular Biomarkers with Clinical Data

Golino

Marazzato

Blasi

et al. 2022

JCM

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Background. Nowadays, it is still not possible to clinically distinguish whether an increase in high-sensitivity cardiac troponin (hs-cTn) values is due to myocardial injury or an acute coronary syndrome (ACS). Moreover, predictive data regarding hs-cTnT in an emergency room (ER) setting are scarce. This monocentric retrospective study aimed to improve the knowledge and interpretation of this cardiac biomarker in daily clinical practice. Methods. Consecutive adult patients presenting at the ER and hospitalized with a first abnormal hs-cTnT value (≥14 ng/L) were enrolled for 6 months. The baseline hs-cTnT value and the ensuing changes and variations were correlated with the clinical presentation and the type of diagnosis. Subsequently, multivariable models were built to assess which clinical/laboratory variables most influenced hospital admissions in the investigated population analyzed according to the final reason for hospitalization: (1) cardiovascular vs. non-cardiovascular diagnosis, and (2) ACS vs. non-ACS one. Results. A total of 4660 patients were considered, and, after a first screening, 4149 patients were enrolled. Out of 4129 patients, 1555 (37.5%) had a first hs-cTnT ≥14 ng/L, and 1007 (65%) were hospitalized with the following types of diagnosis: ACS (182; 18%), non-ACS cardiovascular disease (337; 34%) and non-cardiovascular disease (487; 48%). Higher hs-cTnT values and significant hs-cTnT variations were found in the ACS group (p < 0.01). The mean percentage of variation was higher in patients with ACS, intermediate in those with non-ACS cardiovascular disease, and low in those with non-cardiovascular disease (407.5%, 270.6% and 12.4%, respectively). Only syncope and CRP (OR: 0.08, 95% CI: 0.02–0.39, p < 0.01 and OR: 0.9988, 95% CI: 0.9979–0.9998, p = 0.02, respectively) or CRP (OR: 0.9948, 95% CI: 0.9908–0.9989, p = 0.01) and NT-proBNP (OR: 1.0002, 95% CI: 1.0000–1.0004, p = 0.02) were independent predictors of a cardiovascular disease diagnosis. On the other hand, only chest pain (OR: 22.91, 95% CI: 3.97–132.32, p < 0.01) and eGFR (OR: 1.04, 95% CI: 1.004–1.083, p = 0.03) were associated with the ACS diagnosis. Conclusions. Differently from the investigated biomarkers, in this study, only clinical variables predicted hospitalizations in different patients’ subgroups.

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An Italian registry of chest pain patients in the emergency department: clinical predictors of acute coronary syndrome

Cited by 15 publications

References 49 publications

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram

High-Sensitivity Cardiac Troponin T and the Diagnosis of Cardiovascular Disease in the Emergency Room: The Importance of Combining Cardiovascular Biomarkers with Clinical Data

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