Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients

Rude, Robert E.; Poole, W. Kenneth; Muller, James E.; Turi, Zoltan G.; Rutherford, John D.; Parker, Corette B.; Roberts, Robert; Raabe, Daniel S.; Gold, Herman K.; Stone, Peter H.; Willerson, James T.; Braunwald, Eugene

doi:10.1016/0002-9149(83)90508-8

Cited by 257 publications

(57 citation statements)

References 14 publications

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“…Therefore, from the parameters investigated, only the GDx VCC NFI would be considered a good test to differentiate glaucoma from normals in our study. The ROC curve area for the NFI in this situation was actually similar to those found for several clinical tests widely used in medicine when these tests are applied to challenging situations of diagnosis, such as the electrocardiogram for diagnosing myocardial infarction 22,23 or magnetic resonance imaging for diagnosing multiple sclerosis. 24 In our study, we used evidence of documented progressive disc change to separate glaucoma suspect patients in those who were disease positive versus disease negative.…”

Section: Discussionsupporting

confidence: 75%

Comparison of Retinal Nerve Fiber Layer and Optic Disc Imaging for Diagnosing Glaucoma in Patients Suspected of Having the Disease

et al. 2008

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Purpose-To compare retinal nerve fiber layer (RNFL) and optic disc topographic imaging for detection of optic nerve damage in patients suspected of having glaucoma. Design-Observational cohort study.Participants-A cohort of 82 patients suspected of having glaucoma based on the appearance of the optic nerve.Methods-All patients were imaged using the GDx VCC scanning laser polarimeter and HRT (software version 3.0) confocal scanning laser ophthalmoscope. All patients had normal standard automated perimetry visual fields at the time of imaging and were classified based on history of documented stereophotographic evidence of progressive glaucomatous change in the appearance of the optic nerve occurring before the imaging sessions.Main Outcome Measures-Areas under the receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracies of GDx VCC and the HRT.Results-Forty eyes with progressive glaucomatous optic nerve change were included in the glaucoma group, and 42 eyes without any evidence of progressive damage to the optic nerve followed untreated for an average time of 8.97±3.08 years were included in the normal group. The area under the ROC curve for the best parameter from GDx VCC (nerve fiber indicator [NFI]) was significantly larger than that of the best parameter from the HRT (rim volume) (0.83 vs. 0.70; P = 0.044). The NFI parameter also had a larger ROC curve area than that of the contour line-independent parameter glaucoma probability score (0.83 vs. 0.68; P = 0.023). Assuming borderline results as normal, the Moorfields regression analysis classification had a sensitivity of 48% for specificity of 69%. For a similar specificity (70%), the parameter NFI had a significantly larger sensitivity (83%) (P = 0.003).Conclusions-Retinal nerve fiber layer imaging with GDx VCC had a superior performance versus topographic optic disc assessment with the HRT for detecting early damage in patients suspected of having glaucoma. For glaucoma diagnosis, these results suggest that GDx VCC may offer advantage over the HRT when these tests are combined with clinical examination of the optic nerve.To diagnose disease, a clinician integrates the constellation of symptoms and/or signs of a presenting patient and then assigns a level of certainty regarding its presence. In the case of glaucoma evaluation, the process generally starts with the medical interview and history. It is NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript followed by clinical examination, which generally includes slit-lamp examination, intraocular pressure (IOP) measurement, and optic nerve examination. After this information is collected, the clinician hypothesizes about the chance that glaucoma is present and can order additional tests, such as the visual field (VF).It is not unusual for a patient to present with suspicious appearance of the optic disc and normal or inconclusive VF tests. In this situation, additional testing, such as optic disc and/or retinal nerve fiber layer (RNFL) imaging,...

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Section: Discussionsupporting

confidence: 75%

Comparison of Retinal Nerve Fiber Layer and Optic Disc Imaging for Diagnosing Glaucoma in Patients Suspected of Having the Disease

et al. 2008

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“…These facts have been shown to be responsible for the considerable reduction in hospital costs, of 40-60% without an increase in the rate of cardiovascular events inside or outside of the hospital 8,9,28,29 . Some authors have demonstrated that it is possible to identify subgroups of patients with chest pain and low risk of complications, using a clinical history and the electrocardiogram 5,25,30 . These patients may be admitted to lowcost units without incurring an increase risk, which improves the cost-benefit ratio.…”

Section: Discussionmentioning

confidence: 99%

Chest pain in the emergency room. Importance of a systematic approach

Bassan¹,

Scofano²,

Gamarski³

et al. 2000

Arq. Bras. Cardiol.

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“…Unfortunately, the Sgarbossa criteria have not succeeded, partly because the third criterion is not sensitive and specific enough [55], and partly because it has not been widely evaluated using angiography as an endpoint; instead the usual endpoint has been AMI as diagnosed by CK-MB, and this definition includes non-STEMI. ECGs with normal conduction have only 45 % sensitivity for all AMI, but good sensitivity for STEMI [56][57][58][59].…”

Section: Left Bundle Branch Block and Amimentioning

confidence: 99%

Updates on the Electrocardiogram in Acute Coronary Syndromes

Smith

2012

Curr Emerg Hosp Med Rep

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The electrocardiogram (ECG) is the initial test in patients with suspected ACS. The ECG is the defining element of ST-segment elevation myocardial infarction (STEMI). Its most important use is in the detection of acute coronary obstruction, and it is the most important, cost-effective, and immediately available initial test in the decision for emergency reperfusion therapy. There is a recent interest in refining the sensitivity and specificity of the ECG for coronary occlusion, and thus for identifying subtle STEMI, as well as in recognizing pseudoinfarction patterns and thus avoiding false positive cath lab activations. Studies assessing the accuracy of cath lab activation, the differentiation of precordial ST-segment elevation due to normal variant from that of anterior STEMI, the diagnosis of STEMI in the presence of left bundle branch block, the differentiation of benign inferior ST-segment elevation from that of inferior STEMI, and the importance of ST-segment elevation in lead aVR will be discussed.

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Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients

Cited by 257 publications

References 14 publications

Comparison of Retinal Nerve Fiber Layer and Optic Disc Imaging for Diagnosing Glaucoma in Patients Suspected of Having the Disease

Comparison of Retinal Nerve Fiber Layer and Optic Disc Imaging for Diagnosing Glaucoma in Patients Suspected of Having the Disease

Chest pain in the emergency room. Importance of a systematic approach

Updates on the Electrocardiogram in Acute Coronary Syndromes

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