Examining Renal Impairment as a Risk Factor for Acute Coronary Syndrome: A Prospective Observational Study

Modification of the Thrombolysis in Myocardial Infarction risk score for patients presenting with chest pain to the emergency department

“…The g‐TIMI score included the four s‐TIMI variables plus two GRACE variables (SBP and eGFR). The finding that SBP and eGFR are predictors of ACS is in line with previous research on the cohort of patients presenting to ED with potential ACS. Incorporating these variables into the TIMI score slightly increased sensitivity, but reduced specificity and only enabled rule‐out for 12.0% of patients.…”

Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department

“…This score encompasses the measurement of hs-cTn concentration, glucose level and estimated glomerular filtration rate (eGFR), with eGFR also providing important prognostic information in this setting. 13 Specifically, for ST-segment elevation MI (STEMI), high glucose concentrations at admission to the emergency department identify patients who are more hemodynamically unstable, have a larger infarct size and have a high 30-day mortality. 14 Moreover, eGFR calculated by the CKD-EPI creatinine equation has been shown to be an independent predictor of major adverse cardiac outcomes in patients with acute coronary syndrome.…”

“…The cut-offs used for each test were based on accepted normal levels and low-risk clinical cut points, with values of eGFR of 90 mL/min/1.73 m 2 or more, glucose of less than 5.6 mmol/L, hs-cTnI of less than 4 ng/L and of hs-cTnT less than 8 ng/L used to identify patients at low risk (i.e., abnormal value 1 point and normal 0 points). 13,[25][26][27] For hs-cTn, 2 additional cut points were selected based on analytical variation, population and health outcome studies, [26][27][28][29][30][31][32] to have a final CCS range of 0-5 points (i.e., sum of the points for the results for glucose, eGFR and hs-cTn obtained from the patient's blood work at presentation to the emergency department; Supplemental Table 1, Appendix 3, available at www.cmaj.ca/ lookup/suppl/doi:10.1503/cmaj.180144/-/DC1).…”

Utility of Routine Exercise Stress Testing among Intermediate Risk Chest Pain Patients Attending an Emergency Department

“…This was achieved for all end points. Diagnosis of AMI and UAP was based on accepted international standards as described previously [12].…”