Criteria of the German Society of Cardiology for the establishment of chest pain units: update 2014

Post, Felix; Gori, Tommaso; Giannitsis, Evangelos; Darius, Harald; Baldus, Stephan; Hamm, Christian W.; Hambrecht, Rainer; Hofmeister, Hans Martin; Katus, Hugo A.; Perings, Stefan; Senges, Jochen; Münzel, Thomas

doi:10.1007/s00392-015-0888-2

Cited by 43 publications

(30 citation statements)

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“…Thus, even though the overall TTE rate is high, in this regard, awareness should be improved. Recently, the GCS published their first update of the consensus CPU guidelines, replacing the original 2008 publication [34,35,36]. Certification criteria still include spatial and technical recommendations, diagnostic and therapeutic procedures and strategies, collaboration and educational and organizational issues, but also put emphasis on a stronger role for noninvasive imaging methods.…”

Section: Discussionmentioning

confidence: 99%

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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Objectives: To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). Methods: A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. Results: TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. Conclusions: About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.

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Section: Discussionmentioning

confidence: 99%

The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry

et al. 2016

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“…Registry data indicated similar mortality rates between pPCI and CABG, while they sometimes suggested that CABG was better [80,81]. Chest pain units and shock centers in the network generated for MI patients should allow to rapid transfer of CSMI patients to those centers where cardiac catheterization and pPCI are performed [33,37,83]. Only in cases in which emergency cardiac catheterization cannot be performed in a reasonable time period, systemic fibrinolysis should be preferred as the second best option, and cardiac catheterization should be performed because systemic fibrinolysis is not as effective as catheter revascularization [84].…”

Section: Types Of Revascularizationmentioning

confidence: 99%

Cardiogenic Shock

Türker¹

2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short-and long-term survival of patients.to survive [2]. CS occurs in approximately 5-8% of inpatients with ST-elevation myocardial infarctions (STEMI) and has a mortality rate of more than 30% [1]. CS is caused by end-organ hypoperfusion due to impaired cardiac pump function. Although CS-related mortality has declined significantly over the past decade, it continues to remain high, especially in cases of its coexistence with ischemic heart disease. Acute coronary syndrome (ACS) is still the most common cause of CS despite significant advances that have been made in its diagnosis and treatment. The most successful form of treatment is primary percutaneous coronary intervention (pPCI), which is carried out as rapidly as possible [3]. The recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems also play a role in the pathogenesis and persistence of CS.In cases where CS complicates MI (CSMI), only one in two patients survives after 1 year [4,5]. In a large study including 5782 patients, CSMI had developed in 2.5% of the patients with STEMI before admission to hospital, in 4.3% of them on the first day of hospitalization, and in 2.3% of them afterward [6]. For non-STEMI (NSTEMI) patients, these ratios were 1.2% for each condition [6]. Mortality rates were 45.7% before the hospitalization, 32.8% in the early period, and 54.1% in the late period [7]. Of 1422 CSMI patients, in the SHOCK Trial Registry, a shock is developed following left ventricular failure in 78.5% of them, acute mitral insufficiency in 6.9% of them, acute ventricular septal defect in 3.9% of them, right ventricular failure in 2.8% of them, cardiac tamponade in 1.4% of them, and ...

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“…In hospitals with an IMC, the following specialist medical expertise must be available (1A): 24-Hour availability (presence) 4 Internal medicine 4 Surgery 4 Anaesthesiology 24-Hour availability (on call within 30 min) 4 Additional specialist presence may be necessary depending on special requirements of the patient collective a a For more details, the reader is referred to the recommendations of specialist societies or certification institutions, e. g. Stroke Units [6,[10][11][12] or Chest Pain Units [13,14].…”

Section: Key Statementmentioning

confidence: 99%