Continuous 12‐lead st‐segment monitoring improves identification of low‐risk patients with chest pain and a worse in‐hospital outcome

Abstract

Background: Various strategies have been proposed to improve diagnosis and triage of patients with chest pain at low risk, but uncertainty still exists on the optimal combination of diagnostic tools that should be used in this subset of patients. Hypothesis: The aim of this study was to evaluate the incremental benefit of continuous 12‐lead ST‐segment monitoring over that provided by conventional diagnostic tools in patients with chest pain. Methods: Of 232 consecutive patients referred because of chest pain, 52 were classified as low‐risk according to the Agency for Health Care Policy and Research unstable angina guidelines and observed for 12 h with serial cardiac enzymes and electrocardiograms (ECG) (every 3 h). All patients also underwent both echocardiography at entry and continuous 12‐lead ST‐segment monitoring during the observation period. Results: During a mean hospital stay of 3.7 days (range 1‐14 days), a benign outcome was observed in 37 patients (71%), whereas 15 patients (29%) had major cardiac events or recurrence of chest pain of ischemic origin. Addition of ST‐segment monitoring findings to baseline clinical data as well as to serial enzymes and ECG features added significant incremental prognostic value (p < 0.001). Multivariate analysis showed reproduction of pain by chest pressure (p < 0.05) and presence of ST‐segment changes (≥ 0.1 mV) during 12‐lead ST‐segment monitoring (p < 0.001) as independent predictors of a benign or unfavorable outcome. Conclusions: In low‐risk patients with chest pain, continuous 12‐lead ST‐segment monitoring provides significant incremental diagnostic and prognostic information to currently used clinical, enzymatic, and ECG data, and is helpful in identifying the subset of patients with a worse in‐hospital outcome.

Should Hospitalized Patients With Pneumonia and Cardiac Risk Factors Be on Telemetry?

“…The specificity of ST segment monitoring was higher than typical chest pain (84% vs 73%) in adults evaluated for acute coronary syndrome has been demonstrated. 7 Although ST segment monitoring can detect asymptomatic ischemic episodes, it has been underused in many hospitals, even in patients admitted with acute coronary syndromes. 8 Currently, the indications for the use of telemetry monitoring in patients hospitalized with pneumonia are unclear and usually left to the physician's decision.…”

I Diretriz de Dor Torácica na Sala de Emergência

“…Além disso, a demonstração de estabilidade do segmento ST mostrou 100% de sensibilidade e especificidade para detecção de obstrução coronariana subtotal em relação à obstrução total 56 . O monitor de ST também tem-se mostrado como méto-do de grande utilidade para estratificação de risco em pacientes com angina instável ou mesmo com dor torácica de baixo risco e de etiologia a ser esclarecida, constituindo-se num preditor independente e altamente significativo de morte, infarto agudo do miocárdio não-fatal ou isquemia recorrente [57][58][59] …”