Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain

Kohn, Michael A.; Kwan, Elizabeth; Gupta, Malkeet; Tabas, Jeffrey A.

doi:10.1016/j.jemermed.2005.04.010

Cited by 102 publications

(59 citation statements)

References 18 publications

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“…11 However, most of these studies used other reference diagnoses such as acute coronary syndromes, and all were performed in a setting where the prevalence of coronary artery disease is much higher than that in a primary care setting. 1,16,25 Sox and colleagues developed a logistic function for chest pain in a secondary care setting to estimate the probability of coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Bösner¹,

Haasenritter²,

Becker³

et al. 2010

Canadian Medical Association Journal

110

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Background: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. Methods:We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). Results:The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result ≤ 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). Interpretation:The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care. AbstractPreviously published at www.cmaj.ca @@

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Section: Discussionmentioning

confidence: 99%

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Bösner¹,

Haasenritter²,

Becker³

et al. 2010

Canadian Medical Association Journal

110

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“…3 The American Heart Association (AHA) recommends that patients presenting with chest discomfort or chest pain equivalent receive an electrocardiogram (ECG) within 10 minutes of ED arrival. 4,5 Less than 10% of ED visits for chest pain ultimately prove to be an acute myocardial infarction (AMI), 6,7 and to identify AMI patients among all the patients with chest pain (and the 33% of AMI patients who present without chest pain 8 ), a very large number of patients must receive an ECG within 10 minutes of arrival. Given the high prevalence of ED crowding in the Western world, 9-11 diverting resources to care for one group of patients, such as potential AMI patients, may occur at the expense of other groups.…”

Section: Ré Sumémentioning

confidence: 99%

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Atzema

Austin²,

Tu³

et al. 2011

CJEM

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Objective: The American Heart Association (AHA) recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial infarction patients, but this is based on expert opinion (level of evidence C). We sought to establish an evidence-based benchmark door-to-ECG time.Methods: This retrospective cohort study used a populationbased sample of patients who suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 and 2001. Using cubic smoothing splines, we described (1) the relationship between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI patients who met the benchmark door-to-needle time of 30 minutes based on their door-to-ECG time. We hypothesized nonlinear relationships and sought to identify an inflection point in the latter curve that would define the most efficient (benefit the greatest number of patients) door-to-ECG time. Results: In 2,961 STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 minutes, respectively. There was a linear increase in ECG-to-needle time as the door-to-ECG time increased, up to approximately 30 minutes, after which the ECG-to-needle time remained constant at 53 minutes. The inflection point in the probability of achieving the benchmark door-to-needle time occurred at 4 minutes, after which it decreased linearly, with every minute of door-to-ECG time decreasing the average probability of achievement by 2.2%. Conclusions: Hospitals that are not meeting benchmark reperfusion times may improve performance by decreasing door-to-ECG times, even if they are meeting the current AHA benchmark door-to-ECG time. The highest probability of meeting the reperfusion target time for fibrinolytic administration is associated with a door-to-ECG time of 4 minutes or less.

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“…15 It has also been shown that approximately 4% of patients presenting in emergency care with chest pain are diagnosed with acute myocardial infarction. 16 A multicentre cohort study of patients diagnosed with non-cardiac chest pain attending rapid-access chest pain clinics reported that 2.73% were subsequently diagnosed with angina. 17 As the data are based on recorded diagnoses rather than patient recall, as were previous studies, 1,6 the results are not completely comparable.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality

Ruigómez¹,

Massó-González²,

Johansson³

et al. 2009

Br J Gen Pract

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Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain

Cited by 102 publications

References 18 publications

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality

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