Evaluation of chest pain suspicious for acute coronary syndrome: use of an accelerated diagnostic protocol in a chest pain evaluation unit

Kirk, J. Douglas; Diercks, Deborah B.; Turnipseed, Samuel D.; Amsterdam, Ezra A.

doi:10.1016/s0002-9149(00)00755-4

Cited by 39 publications

(18 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If on one hand inappropriate admission of non-cardiac chest pain patients is an enormous, avoidable cost for society and an avoidable loss of time for the patient, these missed diagnoses account for 20% of malpractice indemnities [6,7]. Unnecessary admissions in Coronary Care Units cost 0167-5273/$ -see front matter D 2004 Elsevier Ireland Ltd. All rights reserved.…”

mentioning

confidence: 99%

Stress echo in chest pain unit: the SPEED trial

Bedetti¹,

Pasanisi

Tintori

et al. 2005

International Journal of Cardiology

View full text Add to dashboard Cite

mentioning

confidence: 99%

Stress echo in chest pain unit: the SPEED trial

Bedetti¹,

Pasanisi

Tintori

et al. 2005

International Journal of Cardiology

View full text Add to dashboard Cite

“…This approach is safe and cost-effective, but is limited to patients who can exercise and have a normal baseline ECG. 20 Resting single-photon emission computed tomography (SPECT) imaging during chest pain has a relevant role for ACS (sensitivity, 90%-100%; specificity, 60%-78%; negative predictive value, 97%-100%). [21][22][23][24][25] The addition of stress imaging in stable patients improves diagnostic accuracy.…”

Section: Testing Optionsmentioning

confidence: 99%

Evaluation of Acute Chest Pain in the Emergency Department

Yoon

Wann²

2011

Cardiology in Review

View full text Add to dashboard Cite

Triage of patients with acute, potentially life-threatening chest pain is one of the most important issues currently facing physicians in the emergency department. Appropriate evaluation of these patients begins with a skilled assessment of the individual patient's presenting symptoms and a careful review of his or her history and physical examination, often followed by serial recording of electrocardiograms and measurement of serum biochemical markers such as troponin and d-dimer. Stress testing, often accompanied by rest and stress myocardial perfusion imaging or echocardiography, and other diagnostic testing such as radionuclide lung scanning and invasive angiography may be required. A rapid, accurate, and cost-effective approach for the evaluation of emergency department patients with chest pain is needed. Development of newer generations of multidetector computed tomographic (MDCT) scanners, which are capable not only of performing high-quality noninvasive coronary angiography, but also concurrent aortic and pulmonary angiography, has led to increased use of MDCT for the so-called "triple rule out." MDCT is used for the detection of 3 of the most common life-threatening causes of chest pain-coronary artery disease, acute aortic syndrome, and pulmonary emboli. While triple rule-out protocol can be very useful and potentially cost effective when used appropriately, concern has risen regarding the overuse of this technology, which could expose patients to unnecessary radiation and iodinated contrast. The triple rule-out protocol is most appropriate for patients who present with acute chest pain, but are judged to have low to intermediate increased risk for acute coronary syndrome, and whose chest pain symptoms might also be attributed to acute pathologic conditions of the aorta or pulmonary arteries. MDCT should not be used as a routine screening procedure. Continued technical improvements in acquisition speed and spatial resolution of computed tomography images, and development of more efficient image reconstruction algorithms which reduce patient exposure to radiation and contrast, may result in increased popularity of MDCT for "triple rule-out."

show abstract

“…9,11,13,19,20 Positive findings mandate admission for further management. Negative findings are consistent with absence of MI and ischemia at rest.…”

Section: Accelerated Diagnostic Protocolsmentioning

confidence: 99%