Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction

Karam, Nicole; Bataille, Sophie; Marijon, Éloi; Giovannetti, Olivier; Tafflet, Muriel; Savary, Dominique; Benamer, Hakim; Caussin, Christophe; Garot, Philippe; Juliard, Jean‐Michel; Pires, Vanda; Boche, Thévy; Dupas, François; Bail, Gaëlle Le; Lamhaut, Lionel; Laborne, François-Xavier; Lefort, Hugues; Mapouata, Mireille; Lapostolle, Frédéric; Spaulding, Christian; Empana, Jean‐Philippe; Jouven, Xavier; Lambert, Yves

doi:10.1161/circulationaha.116.022954

Cited by 52 publications

(12 citation statements)

References 26 publications

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“…Our findings reinforce the importance of non-chest pain symptoms in ACS patients, because up to 30% of patients do not experience chest pain, leaving them vulnerable to a missed or delayed diagnosis and delayed reperfusion therapy that contributes to adverse health outcomes (El-Menyar et al, 2011). The symptom differences by ACS diagnoses observed in our study may be attributed to variations among patients in collateral circulation, which partially mitigates the consequences of an abrupt coronary artery occlusion in the setting of STEMI (Karam et al, 2016). Patients with ACS may experience sporadic myocardial ischemia that results in both symptomatic and asymptomatic periods or intermittent ECG ST-segment changes (Pelter, 2010).…”

Section: Discussionmentioning

confidence: 67%

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Zègre‐Hemsey

Burke

DeVon

2018

Research in Nursing & Health

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Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS. Patients receiving a cardiac evaluation in the ED were eligible for the study. Thirteen patient-reported symptoms were assessed in triage. Prehospital delay time was calculated as the time from symptom onset until registration in the ED. A total of 1,064 patients were enrolled in five EDs. The sample was 62% male, 70% white, and had a mean age of 60.2 years. Of 474 participants diagnosed with ACS, 118 (25%) had STEMI; 251 (53%) had non-ST elevation myocardial infarction (NSTEMI); and 105 (22%) had unstable angina. Sweating (OR = 1.42 CI [1.01, 2.00]) and shoulder pain (OR = 1.64 CI [1.13, 2.38]) added to the predictive value of an ACS diagnosis when combined with ECG and troponin results. Shortness of breath (OR = 0.71 CI [0.50, 1.00]) and unusual fatigue (OR = 0.60 CI [0.42, 0.84]) were predictive of a non-ACS diagnosis. Sweating predicted shorter prehospital delay (HR = 1.35, CI [1.10, 1.67]); shortness of breath (HR = 0.73 CI [0.60, 0.89]) and unusual fatigue (HR = 0.72, CI [0.57, 0.90]) were associated with longer prehospital delay. Patient-reported symptoms are significantly associated with ACS diagnoses and prehospital delay. Sweating and shoulder pain combined with ECG signs of ischemia may improve the timely detection of ACS in the ED.

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Section: Discussionmentioning

confidence: 67%

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Zègre‐Hemsey

Burke

DeVon

2018

Research in Nursing & Health

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“…Furthermore, if myocardial infarction is suspected, taking aspirin is a first -aid measure and could be recommended by a dispatcher. 23 According to Karam et al, 24 young age, absence of obesity and diabetes mellitus, dyspnea, and a short period between the onset of pain and the emergency call were main predictors of sudden cardiac arrest in the population of patients with ST -segment elevation myocardial infarction (STEMI). The authors prepared a simple score that can optimize dispatching of ambulances…”

Section: Discussionmentioning

confidence: 99%

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry

Nadolny¹,

Zyśko²,

Obremska³

et al. 2020

Kardiol Pol

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“…Ventricular arrhythmias are a major source of early mortality in acute myocardial infarction (MI) 1 and remain a major therapeutic challenge, especially in the pre-hospital phase. They are usually of re-entrant nature and include ventricular tachycardia and fibrillation.…”

Section: Introductionmentioning

confidence: 99%

Ivabradine is as effective as metoprolol in the prevention of ventricular arrhythmias in acute non-reperfused myocardial infarction in the rat

Marciszek

Paterek

Oknińska

et al. 2020

Sci Rep

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Ventricular arrhythmias are a major source of early mortality in acute myocardial infarction (MI) and remain a major therapeutic challenge. Thus we investigated effects of ivabradine, a presumably specific bradycardic agent versus metoprolol, a β-blocker, at doses offering the same heart rate (HR) reduction, on ventricular arrhythmias in the acute non-reperfused MI in the rat. Immediately after MI induction a single dose of ivabradine/ metoprolol was given. ECG was continuously recorded and ventricular arrhythmias were analyzed. After 6 h epicardial monophasic action potentials (MAPs) were recorded and cardiomyocyte Ca2+ handling was assessed. Both ivabradine and metoprolol reduced HR by 17% and arrhythmic mortality (14% and 19%, respectively, versus 33% in MI, p < 0.05) and ventricular arrhythmias in post-MI rats. Both drugs reduced QTc prolongation and decreased sensitivity of ryanodine receptors in isolated cardiomyocytes, but otherwise had no effect on Ca2+ handling, velocity of conduction or repolarization. We did not find any effects of potential IKr inhibition by ivabradine in this setting. Thus Ivabradine is an equally effective antiarrhythmic agent as metoprolol in early MI in the rat. It could be potentially tested as an alternative antiarrhythmic agent in acute MI when β-blockers are contraindicated.

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Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction

Abstract: At the early phase of STEMI, the risk of prehospital SCA can be determined through a simple score of 5 routinely assessed predictors. This score might help optimize the dispatching and management of patients with STEMI by emergency medical services.

Cited by 52 publications

References 26 publications

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry

Ivabradine is as effective as metoprolol in the prevention of ventricular arrhythmias in acute non-reperfused myocardial infarction in the rat

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