Unidades de dolor torácico. Organización y protocolo para el diagnóstico de los síndromes coronarios agudos

Fernández, Julián Bayón; Ezquerra, Eduardo Alegría; Genover, Xavier Bosch; O’Callaghan, Adolfo Cabadés; Iglesias-Garriz, Ignacio; Nacher, J J Jimenez; Torres, Félix Malpartida de; Romero, Ginés Sanz

doi:10.1016/s0300-8932(02)76574-3

Cited by 57 publications

(11 citation statements)

References 42 publications

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“…Our hospital has a written protocol agreed with the emergency room to establish that all patients with nontraumatic chest pain will have an ECG on arrival, plus troponin testing at baseline and 8 h after onset of pain. 13 When the pain occurs 6 h to 8 h before arrival to the emergency room, the troponin assay is not repeated if the first was negative. In practice, the protocol is specifically designed for patients with chest pain (initial ECG and 1 or 2 troponin assays) and is also applied to patients with other symptoms (eg, dyspnea) that, in the emergency room physician's opinion, require a differential diagnosis with an ACS.…”

Section: Study Samplementioning

confidence: 99%

Troponin Elevation in Patients Without Acute Coronary Syndrome

Bardajı́

Cediel

Carrasquer

et al. 2015

Revista Española de Cardiología (English Edition)

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Section: Study Samplementioning

confidence: 99%

Troponin Elevation in Patients Without Acute Coronary Syndrome

Bardajı́

Cediel

Carrasquer

et al. 2015

Revista Española de Cardiología (English Edition)

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“…Chest pain management is one of the biggest challenges in the emergency department (ED). This symptom accounts for 5 to 20 % of all ED admissions [ 1 ], being the second most common reason to present to the ED in the United States of America [ 2 ]. Causes of chest pain range from musculoskeletal chest pain to potentially life-threatening emergencies as acute coronary syndrome (ACS), aortic dissection or pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score

Leite

Baptista

Leitão

et al. 2015

BMC Cardiovasc Disord

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BackgroundFast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories. We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess the prognostic value of Manchester triage system and of HEART score.MethodsRetrospective observational study including patients admitted to the ED of a tertiary hospital with chest pain as the presenting symptom. The primary outcome was a composite of all-cause mortality, myocardial infarction or unscheduled revascularization at 6 weeks.ResultsWe enrolled 233 patients (age 58 ± 19; 55.4 % males). The most common final diagnosis was non-specific chest pain (n = 86, 36.9 %), followed by ACS (n = 22, 9.4 %). Male gender, smoking and chronic kidney disease were associated with higher risk of ACS. According to Manchester triage system, chest pain patients stratified with red or orange priority had a higher incidence of ACS (16.5 % vs. 3.8 %, p = 0.006). The application of HEART score showed that most patients were in low risk category (56.3 %). The six-week incidence of MACE in each category was 2 %, 15.6 % and 76.9 % (p < 0.001). HEART score accurately predicted the short-term incidence of MACE in chest pain patients (c-statistic 0.880; 95 % CI, 0.807–0.950, p < 0.001).ConclusionsChest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

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“…Las UDT se crearon para reducir tanto el número de pacientes ingresados por dolor torácico de origen no coronario 15 como el de altas de pacientes con SCA [16][17][18][19] y el coste derivado de la atención de estos pacientes 20,21 . En los pacientes con ECG normal o no diagnóstico de isquemia en los que no puede descartarse definitivamente la presencia de una enfermedad coronaria se realiza una estrategia de diagnóstico rápido con pruebas complementarias que permitan confirmar o descartar la presencia de cardiopatía coronaria [1][2][3][4][6][7][8][9][10][11] . Estas pruebas suelen consistir en una determinación de los marcadores de daño miocárdico (habitualmente la troponina 5 ) y una prueba de detección de isquemia [6][7][8][9][10][11] .…”

Section: Discussionunclassified

“…Para estudiar los predictores independientes de enfermedad coronaria se llevó a cabo un análisis multivariable con regresión logística mediante eliminación zación. Aunque los datos sobre UDT en España son aún escasos [2][3][4][5] , las UDT permiten una atención al paciente que refiere dolor torácico o cualquier otro síntoma indicativo de isquemia coronaria basada en la clasificación rápida en grupos de diferente riesgo [1][2][3][4][6][7][8][9][10][11] . La anamnesis, la exploración física, el electrocardiograma (ECG) y la radiografía de tórax son útiles en la valoración del dolor torácico, aunque tienen limitaciones 12 .…”

Section: Métodos Estadísticosunclassified

“…El dolor torácico es uno de los motivos de consulta más frecuentes en un departamento de urgencias y se presenta en el 5-20% de los pacientes que acuden al servicio de urgencias de un hospital general 1 . Uno de los objetivos primordiales de las unidades de dolor torácico (UDT) es la identificación rápida y eficiente de los pacientes de bajo riesgo que no requieren hospitali-VÉASE EDITORIAL EN PÁGS.…”

Section: Introductionunclassified

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