The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): A Multicenter Registry of Patients With Suspicion of Acute Coronary Syndromes Reported Using the Standardized Reporting Guidelines for Emergency Department Chest Pain Studies

Lindsell, Christopher J.; Anantharaman, Venkataraman; Diercks, Deborah B.; Han, Jin H.; Hoekstra, James W.; Hollander, Judd E.; Kirk, J. Douglas; Lim, Swee Han; Peacock, W. Frank; Tiffany, Brian; Wilke, Eric; Gibler, W. Brian; Pollack, Charles V.

doi:10.1016/j.annemergmed.2006.08.005

Cited by 111 publications

(55 citation statements)

References 30 publications

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“…Alternatively, their symptoms may be assumed to be anxiety-related. Of the enormous number of patients who present to the emergency department each year with chest pain, less than 10% are ultimately found to be having an acute myocardial infarction, 21 and anxiety is a common cause of chest pain, shortness of breath and diaphoresis. 22 However, an assumption that anxiety is the cause of the patient's symptoms is of particular concern given that true chest pain of acute myocardial infarction can cause a patient to be obviously anxious.…”

Section: Discussionmentioning

confidence: 99%

The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction

Atzema¹,

Schull²,

Tu³

2011

Canadian Medical Association Journal

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Section: Discussionmentioning

confidence: 99%

The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction

Atzema¹,

Schull²,

Tu³

2011

Canadian Medical Association Journal

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“…This accounts for more than 50% of patients with acute chest pain 11,12 and is typical of broad based ED chest pain patient populations that have only a 5% to 20% risk of an ACS. 3,[5][6][7][8][11][12][13][14] Coronary CTA has high diagnostic accuracy. Janne d'Othee et al, 21 in a meta-analysis of 41 trials with over 2,500 patients, found a sensitivity of 95% and specificity of 85% relative to cardiac catheterization.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13] Although clinical algorithms can successfully risk stratify patients, they have not typically been considered useful in identifying a group of patients with a 30-day 1% risk for an adverse event who can safely be discharged from the ED. [2][3][4][5][6][7][8][9][10][11][12][13][14] Coronary computerized tomographic angiography (CTA) has been shown to have excellent diagnostic accuracy when compared to cardiac catheterization [15][16][17][18][19][20][21] and appears to perform as well as myocardial perfusion imaging in identifying patients at low risk for cardiovascular events. [22][23][24][25][26] Observational studies of coronary CTA have found that patients with normal coronary CTA results are at low risk for adverse events over 1-2 years; however, these studies either were small or involved patients who had other standard assessments to aid in clinical management.…”

mentioning

confidence: 99%

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

Hollander

Chang

Shofer

et al. 2009

Academic Emergency Medicine

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115

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Objectives: Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of lowrisk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied. Methods:The authors prospectively evaluated consecutive low-to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS). Patients with cocaine use, known cancer, and significant comorbidity reducing life expectancy and those found to have significant disease (stenosis ‡ 50% or ejection fraction < 30%) were excluded. Demographics, medical and cardiac history, labs, and electrocardiogram (ECG) results were collected. Patients were followed by telephone contact and record review for 1 year. The main outcome was 1-year cardiovascular death or nonfatal acute myocardial infarction (AMI).Results: Of 588 patients who received coronary CTA in the ED, 481 met study criteria. They had a mean (±SD) age of 46.1 (±8.8) years, 63% were black or African American, and 60% were female. There were 53 patients (11%) rehospitalized and 51 patients (11%) who received further diagnostic testing (stress or catheterization) over the subsequent year. There was one death (0.2%; 95% confidence interval [CI] = 0.01% to 1.15%) with unclear etiology, no AMI (0%; 95% CI = 0 to 0.76%), and no revascularization procedures (0%; 95% CI = 0 to 0.76%) during this time period.Conclusions: Low-to intermediate-risk patients with a Thrombosis In Myocardial Infarction (TIMI) score of 0 to 2 who present to the ED with potential ACS and have a negative coronary CTA have a very low likelihood of cardiovascular events over the ensuing year.ACADEMIC EMERGENCY MEDICINE 2009; 16:693-698 ª

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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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The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): A Multicenter Registry of Patients With Suspicion of Acute Coronary Syndromes Reported Using the Standardized Reporting Guidelines for Emergency Department Chest Pain Studies

Cited by 111 publications

References 30 publications

The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction

The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction

One‐year Outcomes Following Coronary Computerized Tomographic Angiography for Evaluation of Emergency Department Patients with Potential Acute Coronary Syndrome

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

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