Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association

Stępińska, Janina; Lettino, M.; Ahrens, Ingo; Bueno, Héctor; Garcı́a-Castrillo, Luis; Khoury, Abdo; Lancellotti, Patrizio; Müeller, Christian; Münzel, Thomas; Oleksiak, Anna; Petrino, Roberta; Guimenez, Maria Rubini; Zahger, Doron; Vrints, Christiaan J.; Halvorsen, Sigrun; Maria, Elia De; Lip, Gregory Y. H.; Rossini, Roberta; Claeys, Marc J.; Huber, Kurt

doi:10.1177/2048872619885346

Cited by 125 publications

(122 citation statements)

References 92 publications

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“…Providing uniform, central and binding guidelines on managing chest pain patients in SARS-CoV-2-infected and non-infected patients to unify care may be profitable, at least each CPU should be advised to develop corresponding clinical SOPs. Such system may be transferred to a European level, which has recently been put into action [25,26]. To implement obligatory partaking in central data collection to ensure nationwide quality control could bear further benefit.…”

Section: Resultsmentioning

confidence: 99%

Capacity changes in German certified chest pain units during COVID-19 outbreak response

et al. 2020

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Background We sought to determine structure and changes in organisation and bed capacities of certified German chest pain units (CPU) in response to the emergency plan setup as a response to the SARS-CoV-2 pandemic. Methods and results The study was conducted in the form of a standardised telephone interview survey in certified German CPUs. Analyses comprised the overall setting of the CPU, bed capacities, possibilities for ventilation, possible changes in organisation and resources, chest pain patient admittance, overall availability of CPUs and bail-out strategies. The response rate was 91%. Nationwide, CPU bed capacities decreased by 3% in the early phase of COVID-19 pandemic response, exhibiting differences within and between the federal states. Pre-pandemic and pandemic bed capacities stayed below 1 CPU bed per 50,000 inhabitants. 97% of CPUs were affected by internal reorganisation pandemic plans at variable extent. While we observed a decrease of CPU beds within an emergency room (ER) setup and on intermediate care units (ICU), beds in units being separated from ER and ICU were even increased in numbers. Conclusions Certified German CPUs are able to maintain adequate coverage for chest pain patients in COVID-19 pandemic despite structural changes. However, at this time, it appears important to add operating procedures during pandemic outbreaks to the certification criteria of forthcoming guidelines either at the individual CPU level or more centrally steered by the German Cardiac Society or the European Society of Cardiology.

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Section: Resultsmentioning

confidence: 99%

Capacity changes in German certified chest pain units during COVID-19 outbreak response

et al. 2020

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“…The 5 ng/L cutoff has been reported as an appropriate cutoff to rule-out for both Roche and Abbott hs-cTn assays [ 7 , 8 , 25 ]. In this regard, a position paper of the Acute Cardiovascular Care Association which provided an update on the European Society of Cardiology task force report on the management of chest pain provided a management pathway where if the ECG is normal and the hs-cTn is below the limit of detection (e.g., hs-cTnT < 5 ng/L), discharge may be appropriate if the patient is pain free, differential diagnoses excluded and the HEART score is ≤ 3 [ 28 ]. Employing the CCS may further simplify this process and provide additional reassurance in this setting.…”

Section: Discussionmentioning

confidence: 99%

Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department

Kavsak

Cerasuolo

Mondoux

et al. 2020

JCM

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For patients with chest pain who are deemed clinically to be low risk and discharged home from the emergency department (ED), it is unclear whether further laboratory tests can improve risk stratification. Here, we investigated the utility of a clinical chemistry score (CCS), which comprises plasma glucose, the estimated glomerular filtration rate, and high-sensitivity cardiac troponin (I or T) to generate a common score for risk stratification. In a cohort of 14,676 chest pain patients in the province of Ontario, Canada and who were discharged home from the ED (November 2012–February 2013 and April 2013–September 2015) we evaluated the CCS as a risk stratification tool for all-cause mortality, plus hospitalization for myocardial infarction or unstable angina (primary outcome) at 30, 90, and 365 days post-discharge using Cox proportional hazard models. At 30 days the primary outcome occurred in 0.3% of patients with a CCS < 2 (n = 6404), 0.9% of patients with a CCS = 2 (n = 4336), and 2.3% of patients with a CCS > 2 (n = 3936) (p < 0.001). At 90 days, patients with CCS < 2 (median age = 52y (IQR = 46–60), 59.4% female) had an adjusted HR = 0.51 (95% confidence interval (CI) = 0.32–0.82) for the composite outcome and patients with a CCS > 2 (median age = 74y (IQR = 64–82), 48.0% female) had an adjusted HR = 2.80 (95%CI = 1.98–3.97). At 365 days, 1.3%, 3.4%, and 11.1% of patients with a CCS < 2, 2, or >2 respectively, had the composite outcome (p < 0.001). In conclusion, the CCS can risk stratify chest pain patients discharged home from the ED and identifies both low- and high-risk patients who may warrant different medical care.

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“…Numerous novel risk scores and accelerated diagnostic pathways have been developed and validated since the publication of these guidelines. The ESC Task Force on Chest Pain recommends the use of the HEART-score for patients with suspected ACS, stating that it most closely follows the clinical reasoning process in the diagnosis of acute chest pain [ 21 ]. However, it is still unclear which risk score or pathway might be considered best in ruling out low risk patients, and physicians are often inclined to practice their risk assessment strategy based on personal preference and clinical experience.…”

Section: Risk Scores Used At Presentationmentioning

confidence: 99%

Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

Yin

Azzahhafi

James

2020

JCM

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Risk scores are widely used in patients with acute coronary syndrome (ACS) prior to treatment decision-making at different points in time. At initial hospital presentation, risk scores are used to assess the risk for developing major adverse cardiac events (MACE) and can guide clinicians in either discharging the patients at low risk or swiftly admitting and treating the patients at high risk for MACE. During hospital admission, risk assessment is performed to estimate mortality, residual ischemic and bleeding risk to guide further in-hospital management (e.g., timing of coronary angiography) and post-discharge management (e.g., duration of dual antiplatelet therapy). In the months and years following ACS, long term risk can also be assessed to evaluate current treatment strategies (e.g., intensify or reduce pharmaceutical treatment options). As multiple risk scores have been developed over the last decades, this review summarizes the most relevant risk scores used in ACS patients.

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Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association

Cited by 125 publications

References 92 publications

Capacity changes in German certified chest pain units during COVID-19 outbreak response

Capacity changes in German certified chest pain units during COVID-19 outbreak response

Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department

Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

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