Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome

Loten, Conrad; Jamcotchian, Melissa; Hullick, Carolyn; MacElduff, Patrick; Attia, John; Marley, John

doi:10.1111/j.1742-6723.2009.01229.x

Cited by 14 publications

(20 citation statements)

References 23 publications

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“…Forty-one percent of chest pain patients were admitted to CCU with diagnosis of ACS. The rate of hospitalization with ACS diagnosis was similar with other studies (1, 3–7). …”

Section: Discussionsupporting

confidence: 90%

“…We found cardiac events in 3.1% of those non-cardiac chest pain patients which is slightly higher than other studies from developed countries. The likely reasons for this difference are adherence to guidelines by physicians, using computer-assisted tools and quality assurance of patients' assessment in different times of day (1, 6). …”

Section: Discussionmentioning

confidence: 99%

“…This presentation suggests acute coronary syndromes (ACS). However, after diagnostic evaluation, only 15% – 25% of these patients have ACS (1). …”

Section: Introductionmentioning

confidence: 99%

“…Loten et al, in a large study in Australia, showed that 1% of patients discharged from ED without a diagnosis of ACS, had a cardiac event within one month (1). Miller et al showed that 2.8 % of patients discharged from ED with a diagnosis of non-cardiac chest pain had an adverse cardiac event after discharge (2).…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study

Soltani¹,

Mirzaei²,

Amin³

et al. 2016

Ethiop J Health Sci

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BACKGROUND: Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. METHODS: Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-STelevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. RESULTS: Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). CONCLUSION: The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

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“…Forty-one percent of chest pain patients were admitted to CCU with diagnosis of ACS. The rate of hospitalization with ACS diagnosis was similar with other studies (1, 3–7). …”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

“…This presentation suggests acute coronary syndromes (ACS). However, after diagnostic evaluation, only 15% – 25% of these patients have ACS (1). …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study

Soltani¹,

Mirzaei²,

Amin³

et al. 2016

Ethiop J Health Sci

View full text Add to dashboard Cite

show abstract

“…The identification of patients at high risk for acute coronary syndrome in ED using conventional assessment of clinical symptoms, electrocardiogram (ECG), and cardiac enzymes is frequently challenging. The misdiagnosis or overdiagnosis of patients with acute chest pain can be associated with serious clinical events or a waste of medical resources, respectively [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Lee¹,

Chang²,

Cho³

et al. 2015

Int J Cardiovasc Imaging

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Left ventricular strain echocardiography is reported to be more sensitive in detecting myocardial ischemia than conventional transthoracic echocardiography (TTE). We evaluated the usefulness of 2D strain analysis for the assessment of acute chest pain in emergency department (ED). Patients presenting to ED with acute chest pain were recruited. Patients with ST-elevation myocardial infarction, known coronary artery disease (CAD), non-ischemic cardiomyopathy, or non-cardiac chest pain were excluded. The pretest probability of CAD and TTEs were evaluated in all patients. TTEs included visual assessments of regional wall motion abnormality (RWMA) and analysis of global and regional longitudinal strain (GLS and RLS). The diagnosis of CAD and the occurrence of cardiac events during 1 month after ED visit were reviewed. Cardiac events were observed in 25% of total 104 patients, and CAD was detected in 36% of 69 patients with coronary imaging tests. Compared to RWMA, RLS showed higher sensitivity (sensitivity/specificity = 64/89 vs. 92/77%) with similar diagnostic accuracy (79.7 vs. 82.6%, p = 0.791) for CAD. RLS also demonstrated better diagnostic performance than either GLS (sensitivity/specificity = 92/57%) or pretest probability (sensitivity/specificity = 72/64 %). Similarly, RLS had the higher predictive value for 1-month cardiac events. In multivariable analyses including pretest probability, LVEF, RWMA, cardiac enzyme, GLS, and RLS; only pretest probability (OR 1.91, 95% CI 1.22-2.99, p = 0.005) and RLS (OR 25.42, 95 % CI 1.84-342.04, p = 0.016) independently predicted CAD. Strain echocardiography appears to be effective in diagnosing CAD and predicting future events with high sensitivity and negative predictive value in acute chest pain patients visiting ED.

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Erratum to: Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Lee

Chang

Cho

et al. 2015

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Adverse outcomes following emergency department discharge of patients with possible acute coronary syndrome

Cited by 14 publications

References 23 publications

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study

Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

Erratum to: Role of strain values using automated function imaging on transthoracic echocardiography for the assessment of acute chest pain in emergency department

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