Examining the Signs and Symptoms Experienced by Individuals With Suspected Acute Coronary Syndrome in the Asia-Pacific Region: A Prospective Observational Study

Greenslade, Jaimi; Cullen, Louise; Parsonage, William; Reid, Christopher M.; Body, Richard; Richards, A. Mark; Hawkins, Tracey; Lim, Swee Han; Than, Martin

doi:10.1016/j.annemergmed.2012.05.008

Cited by 37 publications

(26 citation statements)

References 23 publications

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“…This finding adds to our understanding about symptomology in patients with AMI 26. In patients being investigated for ACS, symptoms may be no more useful in distinguishing T1MI and T2MI than they are in distinguishing MI from other causes of chest pain.…”

Section: Discussionmentioning

confidence: 74%

Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study

et al. 2017

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T2MIs comprised one quarter of all MIs diagnosed in the ED. Among patients presenting to the ED with symptoms of ACS, symptoms do not allow clinicians to reliably differentiate patients with T1MI and T2MI. Prior hypertension, tachycardia and abnormal non-ischaemic ECGs are seen more often in T2MI compared with T1MI. One-year mortality was substantial in patients with T1MI and T2MI, but low power precludes conclusions about mortality differences between groups.

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Section: Discussionmentioning

confidence: 74%

Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study

et al. 2017

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“…As this was a planned substudy, no formal power calculation was undertaken, however previous observational studies reporting the diagnostic utility of chest pain characteristics have typically recruited upwards of 400 participants (13,14,(16)(17)(18)(19). Chi-squared analyses were used to generate 2 x 2 tables for the calculation of sensitivity, specificity, 95% confidence intervals are reported.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, evidence examining the value of typical symptoms in patients presenting with chest pain in the acute setting have demonstrated a poor correlation with the final diagnosis of acute coronary syndrome (3,(13)(14)(15)(16)(17)(18)(19). However, these studies have tended to either include patients with diagnostic ECG changes , focus on specific chest pain characteristics rather than overall typicality, or use M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 research nurses to extract this information.…”

Section: Introductionmentioning

confidence: 89%

“…The applicability of the results may be limited by the characteristics of the population selected. The inclusion of predominantly white Caucasian patients may limit the applicability to international settings, especially as crosscultural differences in symptom reporting exist (18). The upper age cut-off of ≥80 years was chosen for pragmatic institutional reasons as patients were cared for by different inpatient teams.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

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‘Chest Pain Typicality’ in Suspected Acute Coronary Syndromes and the Impact of Clinical Experience

Carlton

Than

Cullen

et al. 2015

The American Journal of Medicine

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“…Because it is so often impossible to differentiate chest pain caused by an acute coronary syndrome from less serious causes on the basis of a patient's symptoms,2 3 patients with previous history4 or ECG,5 are routinely admitted for serial troponin testing. This is limited by the need to repeat troponin testing hours after admission due to the lack of sensitivity of troponin at the time of first presentation to the emergency department (ED), even with a high sensitivity assay 6.…”

Section: Introductionmentioning

confidence: 99%

The Manchester Acute Coronary Syndromes (MACS) decision rule: validation with a new automated assay for heart-type fatty acid binding protein

et al. 2014

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ObjectiveThe Manchester Acute Coronary Syndromes (MACS) decision rule may enable acute coronary syndromes to be immediately ‘ruled in’ or ‘ruled out’ in the emergency department. The rule incorporates heart-type fatty acid binding protein (h-FABP) and high sensitivity troponin T levels. The rule was previously validated using a semiautomated h-FABP assay that was not practical for clinical implementation. We aimed to validate the rule with an automated h-FABP assay that could be used clinically.MethodsIn this prospective diagnostic cohort study we included patients presenting to the emergency department with suspected cardiac chest pain. Serum drawn on arrival was tested for h-FABP using an automated immunoturbidimetric assay (Randox) and high sensitivity troponin T (Roche). The primary outcome, a diagnosis of acute myocardial infarction (AMI), was adjudicated based on 12 h troponin testing. A secondary outcome, major adverse cardiac events (MACE; death, AMI, revascularisation or new coronary stenosis), was determined at 30 days.ResultsOf the 456 patients included, 78 (17.1%) had AMI and 97 (21.3%) developed MACE. Using the automated h-FABP assay, the MACS rule had the same C-statistic for MACE as the original rule (0.91; 95% CI 0.88 to 0.92). 18.9% of patients were identified as ‘very low risk’ and thus eligible for immediate discharge with no missed AMIs and a 2.3% incidence of MACE (n=2, both coronary stenoses). 11.1% of patients were classed as ‘high-risk’ and had a 92.0% incidence of MACE.ConclusionsOur findings validate the performance of a refined MACS rule incorporating an automated h-FABP assay, facilitating use in clinical settings. The effectiveness of this refined rule should be verified in an interventional trial prior to implementation.Trial registration numberUK CRN 8376.

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Examining the Signs and Symptoms Experienced by Individuals With Suspected Acute Coronary Syndrome in the Asia-Pacific Region: A Prospective Observational Study

Cited by 37 publications

References 23 publications

Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study

Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study

‘Chest Pain Typicality’ in Suspected Acute Coronary Syndromes and the Impact of Clinical Experience

The Manchester Acute Coronary Syndromes (MACS) decision rule: validation with a new automated assay for heart-type fatty acid binding protein

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