Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

Gibler, W. Brian; Lewis, Larry M.; Erb, Roy E.; Makens, Paul K; Kaplan, Barry; Vaughn, R.H.; Biagini, A.; Blanton, J; Wb, Campbell

doi:10.1016/s0196-0644(05)82598-3

Cited by 193 publications

(62 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with chest pain of uncertain origin often undergo a period of observation varying from 6 to 12 hours, serial cardiac enzyme sampling, [15][16][17][18][19] ECGs, and possibly provocative stress testing. 20 As many hospitals face situations with decreased inpatient capacity resulting in "bed block," 21 management of chest pain in the ED can possibly decrease in-hospital admissions for evaluation of chest pain.…”

Section: Discussionmentioning

confidence: 99%

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Ong

Ying

Yap

et al. 2016

CJEM

View full text Add to dashboard Cite

Objectives: The new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED. Methods: This prospective cohort study involved patients attended to at the ED of a large urban centre. Patients of at least 25 years old, presenting with stable chest pain and a non-diagnostic ECG, and with no history of active coronary artery disease were included in the study. The main outcome measures were cardiac events, angioplasty, or coronary artery bypass within 30 days of enrolment. Results: The study included 1690 patients from 27 August 2000 to 1 May 2002, with 661 patients fulfilling the VCP criteria. Of those for early discharge, 24 had cardiac events and 13 had angioplasty or bypass at 30 days, compared to 91 and 41, respectively, for those unsuitable for discharge. This gave the rule a sensitivity of 78.1% for cardiac events, including angioplasty and bypass. Specificity was 41.0%, and negative predictive value (NPV) was 94.4%. Conclusion: We found the new VCP Rule to have moderate sensitivity and poor specificity for adverse cardiac events in our population. With an NPV of less than 100%, this means that a small proportion of patients sent home with early discharge would still have adverse cardiac events. RÉSUMÉObjectifs: Selon la nouvelle règle de Vancouver sur la douleur thoracique, il est recommandé que les patients qui présentent des douleurs thoraciques mais qui connaissent un faible risque de syndrome coronarien aigu puissent être renvoyés peu de temps après leur arrivée au service des urgences (SU), soit dans les deux heures suivantes. L'étude visait à évaluer la performance de la nouvelle règle de Vancouver chez des patients d'origine asiatique présentant des douleurs thoraciques, au SU. Méthode: Il s'agit d'une étude de cohorte, prospective, à laquelle ont participé des patients traités dans un SU d'un important centre urbain. Ont été sélectionnés des patients âgés d'au moins 25 ans, qui présentaient une douleur thoracique stable mais chez qui l'ECG s'est révélé non concluant et qui n'avaient pas d'antécédents de coronaropathie active. Les principaux critères d'évaluation consistaient en la survenue d'événements cardiaques ou encore en la réalisation d'une angioplastie ou d'un pontage coronarien dans les 30 jours suivant l'inclusion dans l'étude. Résultats: Au total, 1690 patients ont participé à l'étude, du 27 août 2000 au 1 er mai 2002, dont 661 répondaient aux critères de la nouvelle règle de Vancouver. Parmi ceux qui ont été renvoyés peu de temps après leur arrivée, 24 ont subi un événement cardiaque et 13 autres, une angioplastie ou un pontage coronarien au bout de 30 jours contre 91 et 41 respectivement parmi ceux qui n'étaient pas en état de quitter l'hôpital. Ainsi, la sensibilité de la règle s'est étab...

show abstract

Section: Discussionmentioning

confidence: 99%

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Ong

Ying

Yap

et al. 2016

CJEM

View full text Add to dashboard Cite

show abstract

“…Of the two cardiac biomarkers, troponin has slower release than CK-MB; this may result in fewer patients having positive cardiac biomarker tests in the ED. 7,20,21 But this effect is small because the difference between biomarkers is small: 95% sensitivity at 8 hours versus 10 hours of symptoms, and the proportion positive in the ED is low and comparable. 21 The introduction of troponin biomarker assays may identify some patients with myocardial necrosis who were not previously identified: those with elevations in troponin without elevation in CK-MB.…”

Section: Discussionmentioning

confidence: 99%

“…21 The introduction of troponin biomarker assays may identify some patients with myocardial necrosis who were not previously identified: those with elevations in troponin without elevation in CK-MB. 7,20,21 But this effect is small, because both types of cardiac biomarker tests have 95% or greater specificity, 21 and affect AMI discharge diagnosis, not the diagnosis on admission.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Failure to diagnose AMI occurs because many patients present atypically, 1,6 without positive electrocardiography or cardiac biomarker tests in the emergency department (ED). 7,8 A related quality-of-care problem is the delay in AMI diagnosis for patients admitted to the hospital. Many AMI therapies are time sensitive, requiring administration early in the course of the disease.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Delay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment

Graff

Wang

Borkowski

et al. 2006

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…14) Traditional biochemical markers such as CK and CKMB do not have high sensitivity and specificity rates in diagnosing small infarcts and the area under risk. 3,6,[15][16][17][18][19] In addition, cTnT has high sensitivity and specificity rates in the determination of myocardial injury, and a close chimeric relationship has been shown between myocardial destruction and the cTnT released from cells. 5) With these qualifications, in our study, the values of cTnT in the prediction of LV function have been investigated using a rapid bedside assay.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Importance of Predischarged Troponin T Levels in Acute Anterior Myocardial Infarction

et al. 2004

View full text Add to dashboard Cite

SUMMARYThe baseline cardiac troponin T (cTnT) level strongly predicts short-term mortality in acute coronary syndromes, but the added value of predischarged (7 th day) measures to predict short-term outcome and left ventricular (LV) remodeling in patients with ST elevation myocardial infarction (MI) is controversial.Baseline, peak and predischarged cTnT results were evaluated in 52 patients (15 females, 37 males, mean age, 54.4 ± 8.8 years) with first acute anterior MI. There were 4 deaths (all cardiac origin) during the 30 day follow up period. Kaplan-Meier analysis revealed patients with a predischarged serum cTnT level higher than the median level (1.2 ng/mL) had a higher mortality rate than those with submedian levels (P < 0.05). Additionally, the highest correlation rate was found between predischarged cTnT values and LV ejection fraction (LV-EF, r = -0.58, P < 0.002). There were no differences between the groups in the 7 th day left ventricular diastolic parameters, but the 30 th day isovolumetric relaxation time and mitral E wave deceleration time were shorter (146.9 ± 30.1 vs 129 ± 23.4 msec, P = 0.025 and, 185.8 ± 51.8 vs 144.6 ± 58.1 msec, P = 0.012) in patients with higher predischarged cTnT level.High levels of predischarged cTnT levels in patients admitted with first acute anterior MI defines a subgroup. These patients have poor systolic and diastolic functions and are at increased risk of short term mortality. This group of patients may have benefit from early intensive treatment strategies before discharge. (Jpn Heart J 2004; 45: 43-52) Key words: Troponin, Myocardial infarction, Remodeling ACCUMULATING data show that serum cardiac Troponin T (cTnT) and I are the most sensitive markers for myocardial injury. The greatest potential may lie in risk stratification because these parameters are more closely linked to mortality than CKMB or myoglobin. 1-5)Short and long-term left ventricular functions are important prognostic criteria in acute myocardial infarction. Presence of myocardial damage and its severity in these patients can be assessed from the myocardial proteins appearing

show abstract

Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

Cited by 193 publications

References 60 publications

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Validation of the new Vancouver Chest Pain Rule in Asian chest pain patients presenting at the emergency department

Delay in the Diagnosis of Acute Myocardial Infarction: Effect on Quality of Care and Its Assessment

Prognostic Importance of Predischarged Troponin T Levels in Acute Anterior Myocardial Infarction

Contact Info

Product

Resources

About