Task force on the management of chest pain

Erhardt, Leif; Herlitz, Johan; Bossaert, Leo; Halinen, Matti; Keltai, Mátyás; Koster, Rudolph W.; Marcassa, Claudio; Quinn, Tom; Weert, Hcpm van

doi:10.1053/euhj.2002.3194

Cited by 249 publications

(170 citation statements)

References 156 publications

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“…When we were not able to obtain any information regarding some of the considered risk factors, we concluded that the patient did not have that risk factor, avoiding overestimation of coronary risk profile. Resting echocardiography was performed in all patients [2,17].…”

Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

“…Patients with normal serial ECG and troponins, normal echocardiography, and a CP score lower than 4 were considered at very low risk of coronary disease [2,17] and they were discharged and followed up at 6 months. The remaining patients with CP score higher than 4 and without existing known coronary disease were considered low-risk patients and underwent early in-hospital maximal exercise tolerance test (ETT) [4,18].…”

Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

“…To our knowledge, the usefulness of including MS in the diagnostic work-up of patients with acute CP has not been evaluated. Indeed, no standardized prediction rule is yet available for stratification of patients with low-risk CP in the ED [2,17]. Thus, the primary goal of this study was to derive and validate in an ED a clinical prediction rule for prognostication in patients with low-risk CP.…”

Section: Introductionmentioning

confidence: 99%

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A new simple risk score in patients with acute chest pain without existing known coronary disease

Conti

Vanni

Taglia

et al. 2010

The American Journal of Emergency Medicine

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Objective: To derive and validate a prediction rule in patients with acute chest pain (CP) without existing known coronary disease. Methods: Cohort study including 2233 patients with CP. Based on clinical judgment, 1435 were discharged as very low risk and the remaining 798 underwent exercise tolerance test (ETT). End point: 6-month composite of cardiovascular death, nonfatal myocardial infarction, and revascularization. The prediction rule was derived from a randomly selected test cohort (n = 1106) summing factors of variables selected by multivariate regression analysis: CP score higher than 6 (factor of 3), male gender, age older than 50 years, metabolic syndrome, and diabetes mellitus (factor of 1, for each). The prediction rule was validated in the remaining cohort (n = 1127). All patients with CP were categorized into 3 groups: group A (prediction rule 0-1), B (2-4), or C (5-6). Outcomes and prognostic yield of ETT were compared among each group. Results: In the test cohort, 55 patients (5%) reached the composite end point. Event rate increased as the prediction rule increased: 1% for group A, 6% for B, and 25% for C (P b .001). This pattern was confirmed in the validation cohort (P b .001). A normal ETT did not significantly improve the high (99%) negative predictive value in group A and did not succeed in excluding the composite end point (17%) in group C. Conclusions: In patients with acute CP without existing coronary disease, a prediction rule based on clinical characteristics provided a useful method for prognostication with possible implication in decision making.

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Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

Section: Management Of Patients and Study Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A new simple risk score in patients with acute chest pain without existing known coronary disease

Conti

Vanni

Taglia

et al. 2010

The American Journal of Emergency Medicine

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“…1,2 Chest pain is the underlying reason for approximately 1 % of all primary care consultations 3,4 and 2-5 % of all emergency room presentations in Europe as well as the US. 5,6 Chest pain does not always have a cardiac origin.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding AMI and NCCP, it is important to reflect on the fact that NCCP patients, who have a much better prognosis, 12,50 had the same number of contacts during the two years, and also admissions and length of hospital stay the year after inclusion, as those with AMI which is a more serious life-threatening condition. 1,10 Not all of the patients with NCCP had been admitted prior to inclusion, and only a small part of the patients were frequently readmitted. Mayou and Thompson also stated that a minority of their noncardiac patients were heavy users of hospital resources.…”

mentioning

confidence: 99%

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

et al. 2012

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OBJECTIVES: We compared depressive symptoms and healthcare utilization in patients admitted for noncardiac chest pain, acute myocardial infarction, and angina pectoris after hospitalization and at 1-year follow-up. METHODS: One hundred and thirty-one patients with noncardiac chest pain, 66 with acute myocardial infarction, and 70 with angina pectoris completed a depression screening questionnaire and the Montgomery Åsberg Depression Rating Scale. Healthcare utilization data were collected from a population-based, diagnosis-related database. RESULTS: More than 25% of respondents reported depressive symptoms, regardless of diagnosis. At follow-up, 9% had recovered, 19% were still experiencing depressive symptoms, and 13% had developed depressive symptoms. Noncardiac patients with chest pain had similar primary care contacts, but fewer hospital admissions, than patients with an acute myocardial infarction. Patients with angina pectoris and depressive symptoms used the most healthcare services. CONCLUSIONS: Depressive symptoms were common. Patients with noncardiac chest pain used as much primary care as did patients with an acute myocardial infarction. Interventions should focus on identifying and treating depressive symptoms

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Prehospital Cardiac Markers in Defining Ambiguous Chest Pain

Leshem¹,

Abramowitz²,

Malov³

et al. 2011

Arch Intern Med

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T he presentation of a life-threatening acute coronary syndrome is often not straightforward. Electrocardiographic (ECG) features can also be equivocal. The utility of several different types of pointof-care testing in the prehospital setting has been assessed and verified during the past 2 decades, but none has been officially recommended for routine use. 1,2 We therefore designed this retrospective observational study to assess the utility of 3 cardiac markers (troponin I/CK-MB/myoglobin) measured with a stat kit in the prehospital setting for confirming or ruling out acute coronary syndrome (ACS) in patients with nonspecific, nontraumatic chest pain and a nondiagnostic ECG. Methods. SHL telemedicine, a well-established telemedicine system, 3 has subscribers (approximately 60 000) all over Israel, with the telemedicine center based in Tel-Aviv; all subscribers were eligible for study recruitment. The data (January 1, 2001-December 31, 2010) for those who called to complain of 6 hours or more of nonspecific chest pain and who had inconclusive ECGs were retrospectively retrieved from the call center's database (Table). The CARDIAC STATus Troponin I/CK-MB (creatine kinase myocardial band)/Myoglobin assay (Nexus Dx Inc) qualitatively detects these 3 markers in human blood samples using solid-phase chromatographic immunoassay technology. 4 The test is carried out no earlier than 6 hours from symptom onset. The markers in the blood bind ONLINE FIRST | HEALTH CARE REFORM Prevalence and Characteristics of Outpatient Palliative Care Services in California O utpatient palliative care services (PCSs) offer the opportunity to intervene earlier in the disease trajectory and result in improved patient outcomes. 1,2 Outpatient PCSs can provide improved continuity of care, reduce unnecessary rehospitalizations, and address the needs of patients and caregivers. 3 While the potential benefits of outpatient PCSs are increasingly recognized, there is a paucity of information regarding the structure of outpatient PCSs, 4 and, to our knowledge, there are

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Task force on the management of chest pain

Cited by 249 publications

References 156 publications

A new simple risk score in patients with acute chest pain without existing known coronary disease

A new simple risk score in patients with acute chest pain without existing known coronary disease

Depressive symptoms and healthcare utilization in patients with noncardiac chest pain compared to patients with ischemic heart disease

Prehospital Cardiac Markers in Defining Ambiguous Chest Pain

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