Impact of an Abbreviated Cardiac Enzyme Protocol to Aid Rapid Discharge of Patients with Cocaine-associated Chest Pain in the Clinical Decision Unit

Abstract

IntroductionIn 2007 there were 64,000 visits to the emergency department (ED) for possible myocardial infarction (MI) related to cocaine use. Prior studies have demonstrated that low- to intermediate-risk patients with cocaine-associated chest pain can be safely discharged after 9–12 hours of observation. The goal of this study was to determine the safety of an 8-hour protocol for ruling out MI in patients who presented with cocaine-associated chest pain.MethodsWe conducted a retrospective review of patients treated with an 8-hour cocaine chest pain protocol between May 1, 2011 and November 30, 2012 who were sent to the clinical decision unit (CDU) for observation. The protocol included serial cardiac biomarker testing with Troponin-T, CK-MB (including delta CK-MB), and total CK at 0, 2, 4, and 8 hours after presentation with cardiac monitoring for the observation period. Patients were followed up for adverse cardiac events or death within 30 days of discharge.ResultsThere were 111 admissions to the CDU for cocaine chest pain during the study period. One patient had a delta CK-MB of 1.6 ng/ml, but had negative Troponin-T at all time points. No patient had a positive Troponin-T or CK-MB at 0, 2, 4 or 8 hours, and there were no MIs or deaths within 30 days of discharge. Most patients were discharged home (103) and there were 8 inpatient admissions from the CDU. Of the admitted patients, 2 had additional stress tests that were negative, 1 had additional cardiac biomarkers that were negative, and all 8 patients were discharged home. The estimated risk of missing MI using our protocol is, with 99% confidence, less than 5.1% and with 95% confidence, less than 3.6% (99% CI, 0–5.1%; 95% CI, 0–3.6%).ConclusionApplication of an abbreviated cardiac enzyme protocol resulted in the safe and rapid discharge of patients presenting to the ED with cocaine-associated chest pain.

Application of European Society of Cardiology guidelines for evaluating acute coronary syndrome risk in low-risk patients with cocaine-associated chest pain: Findings from the RISK study – An observational analysis

“… [13] Lastly, a more recent study by Guirgis et al (2014) advised an eight-hour discharge protocol which consists of serial cardiac biomarker testing, including troponin T, at 0, 2, 4 and 8 hours after presentation. [14] In this study, which involved 101 patients, neither ACS nor fatalities were reported within the subsequent 30-day follow-up duration. [14] These last three studies show that none of the observed patients developed ACS, which is concordant with the results of this study, suggesting that a prolonged observation period is not necessary for CACP patients.…”

“… [14] In this study, which involved 101 patients, neither ACS nor fatalities were reported within the subsequent 30-day follow-up duration. [14] These last three studies show that none of the observed patients developed ACS, which is concordant with the results of this study, suggesting that a prolonged observation period is not necessary for CACP patients.…”

“…Ruling out ACS in CACP patients with troponin measurement is only investigated in a few studies, but seems to be an accurate and safe predictor. [13] , [14] , [15] , [16] Firstly, Kushman et al (2000) retrospectively analysed 197 low-risk CACP patients who underwent observation with creatine kinase-myocardial band measurements at 0, 3, 6, and 9 hours and later cardiac troponin I at 0, 3, and 6 hours after presentation. [15] Of the 87 % discharged patients, one patient (1 %) had a MACE within three weeks and died due to cardiogenic shock.…”

Risk and Protective Factors of Lifetime Cocaine-Associated Chest Pain

“…CACP is characterized by symptoms similar to those of acute coronary syndrome, including constrictive or oppressive retrosternal pain (11,13,15). However, <6% of patients with transient CACP have myocardial infarction or an underlying coronary lesion (12)(13)(14)(15)(16)(17).…”

Classification of multi-family enzymes by multi-label machine learning and sequence-based descriptors

“…[1][2][3][4] Because the proportion of enzymes in drug target proteins is higher, recognizing enzymes is more and more essential for the research of drug targets. [5][6][7][8][9][10][11] Faced with the urgent need of information about enzymes, the following questions have been raised: can we get the appropriate information on enzymes? If we can, is it enough, abundant and reliable?…”