Early Noninvasive Cardiac Testing After Emergency Department Evaluation for Suspected Acute Coronary Syndrome

Abstract

Professional guidelines recommend noninvasive cardiac testing (NIT) within 72 hours of an emergency department (ED) evaluation for suspected acute coronary syndrome. However, there is inexact evidence that this strategy reduces the risk of future death or acute myocardial infarction (MI).OBJECTIVE To evaluate the effectiveness of early NIT in reducing the risk of death or acute MI within 30 days. DESIGN, SETTING, AND PARTICIPANTSThis retrospective, multicenter cohort study within the Kaiser Permanente Southern California integrated health care delivery system compared the effectiveness of early noninvasive cardiac testing vs no testing in patients with chest pain and in whom acute MI was ruled out who presented to an ED from January 2015 to December 2017. Patients were followed up for up to 30 days after emergency department discharge.EXPOSURES Noninvasive cardiac testing performed within 3 days of an ED evaluation for suspected acute coronary syndrome. MAIN OUTCOMES AND MEASURESThe primary outcome was composite risk of death or acute MI, within 30 days of an ED discharge.RESULTS A total of 79 040 patients were evaluated in this study, of whom 57.7% were female. The mean (SD) age of the cohort was 57 (16) years, and 16 164 patients (21%) had completed early NIT. The absolute risk of death or MI within 30 days was low (<1%). Early NIT had the minor benefit of reducing the absolute composite risk of death or MI (0.4% [95% CI, −0.6% to −0.3%]), and, separately, of death (0.2% [95% CI, −0.2% to −0.1%]), MI (−0.3% [95% CI, −0.5% to −0.1%]), and major adverse cardiac event (−0.5% [95% CI, −0.7% to −0.3%]). The number needed to treat was 250 to avoid 1 death or MI, 500 to avoid 1 death, 333 to avoid 1 MI, and 200 to avoid 1 major adverse cardiovascular event within 30 days. Subgroup analysis revealed a number needed to treat of 14 to avoid 1 death or MI in the subset of patients with elevated troponin. CONCLUSIONS AND RELEVANCEEarly NIT was associated with a small decrease in the risk of death or MI in patients admitted to the ED with suspected acute coronary syndrome, but this clinical strategy may not be optimal for most patients given the large number needed to treat.

Complement C3 identified as a unique risk factor for disease severity among young COVID-19 patients in Wuhan, China

“…Further analysis showed that the significance of complement C3 in young patients was independent of the common risk factors age, gender and the presence versus absence of comorbidities. Risk factors reported previously in COVID-19 infection such as CRP 7 , lactate dehydrogenase 3 and decreased lymphocyte 8 were validated both in young and elderly patient cohorts. Only the D-dimer and procalcitonin did not show significance in the young patient cohort.…”

Evaluation the relationship of left ventricular global longitudinal strain and laboratory parameters in discharged patients with COVID-19: a follow-up study

“…Prior studies found serum ferritin levels associated with disease severity and mortality in COVID-19 infection [ 21 , 22 ]. Besides, Wu et al found high serum ferritin levels associated with the development of ARDS in COVID-19 [ 23 ].…”

Cancer vs. SARS-CoV-2 induced inflammation, overlapping functions, and pharmacological targeting

“…Therefore, it is grossly used to prevent graft rejection during organ transplantation and inhibits inflammation during rheumatoid arthritis (Rodrígues-Perálvarez et al 2014 ; Suarez-Almazor et al 2000 ). Due to its immunosuppressant activity, it is suggested to be used against the cytokine storm in respiratory distress, however, in combination treatments (Vaz et al 2011 ; Shorr et al 2003 ; Wu et al 2020b ). Azithromycin is now shown to reduce the viral load in early SARS-CoV-2 infection either alone or in combination with chloroquine (Rajaiah et al 2020 ; Lagier et al 2020 ).…”