Outcomes in patients with chest pain evaluated in a chest pain unit: The Chest Pain Evaluation in the Emergency Room study cohort

Cullen, Michael W.; Reeder, Guy S.; Farkouh, Michael E.; Kopecky, Stephen L.; Smars, Peter A.; Behrenbeck, Thomas; Allison, Thomas G.

doi:10.1016/j.ahj.2011.02.008

Cited by 19 publications

(17 citation statements)

References 21 publications

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“…As all certified CPUs in Germany must have a 24 hour catheterization facility, it can If an acute coronary syndrome can be ruled out in the CPU, discharge is safe for the patients, as was shown in several trials. 10,13,14 A study evaluating patients' satisfaction demonstrated that patients treated in a CPU had a higher level of satisfaction as compared with those being treated in a general emergency department for acute chest pain. 15 Additionally CPUs have the potential to reduce costs and hospital occupancy.…”

Section: Discussionmentioning

confidence: 99%

Self-referral to chest pain units: results of the German CPU-registry

Nowak

Giannitsis

Riemer

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: Chest pain units (CPUs) are increasingly established in emergency cardiology services. With improved visibility of CPUs in the population, patients may refer themselves directly to these units, obviating emergency medical services (EMS). Little is known about characteristics and outcomes of self-referred patients, as compared with those referred by EMS. Therefore, we described self-referral patients enrolled in the CPU-registry of the German Cardiac Society and compared them with those referred by EMS. Methods and results: From 2008 until 2010, the prospective CPU-registry enrolled 11,581 consecutive patients. Of those 3789 (32.7%) were self-referrals (SRs), while 7792 (67.3%) were referred by EMS. SR-patients were significantly younger (63.6 vs. 70.1 years), had less prior myocardial infarction or coronary artery bypass surgery, but more previous percutaneous coronary interventions (PCIs). Acute coronary syndromes were diagnosed less frequently in the SRpatients (30.3 vs. 46.9%; p<0.0001). SR-patients showed ST-segment changes in their initial ECG in 19.6% of cases. EMSpatients underwent more coronary angiographies (60.0 vs. 47.5%; p<0.0001), while SR-patients underwent more stress tests (11.3 vs. 7.8%; p<0.001). PCI was performed in 32.6% of the EMS-and in 24.0% of the SR-group (p<0.0001).Conclusion: These data demonstrate that patients who contact a CPU as a self-referral are younger, less severely ill and have more non-coronary problems than those calling an emergency medical service. Nevertheless, 30% of self-referral patients had an acute coronary syndrome.

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Section: Discussionmentioning

confidence: 99%

Self-referral to chest pain units: results of the German CPU-registry

Nowak

Giannitsis

Riemer

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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“…5,6) In addition, the pain severity does not seem to be a good predictor of the outcome of myocardial infarction.…”

Section: )mentioning

confidence: 99%

“…2) However, chest pain related to AMI varies signifi cantly both in its intensity 3,4) and incidence. 5,6) In addition, the pain severity does not seem to be a good predictor of the outcome of myocardial infarction. 7) While the evaluation of pain in humans is predominantly based on conscious perception, in animals it relies mainly on behavioral output.…”

Section: )mentioning

confidence: 99%

Behavioral Changes Following Experimentally-Induced Acute Myocardial Infarction in Rats

et al. 2014

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SummaryRats with experimentally-induced acute myocardial infarction (AMI) have proven to be a clinically relevant model for visceral pain. As there are no behavioral data available on rats in the postinfarction period, we aimed to identify specifi c pain-related behavioral changes following AMI to increase the validity of the model. AMI was induced by left coronary artery ligation and pain-related behavior was analyzed using the open fi eld test (OFT) and elevated plus maze (EPM). Morphine was applied following AMI induction to differentiate pain-related changes from those related to nonspecifi c global changes in responsiveness. AMI was histologically confi rmed.Hypolocomotion was consistently evident in all behavioral tests for both the infarcted group and sham group. In the OFT, both AMI and sham rats exhibited less exploratory behavior and less activity. A similar pattern of behavior was observed in EPM, where both surgical groups showed fewer entries to the open arms and spent less time in the open arms. The sham group with an intact pericardium showed the same pattern of activity as control rats. The reduction in activity and rearing observed following AMI was successfully reversed following morphine injection. This effect was abolished after naloxone application allowing us to attribute observed changes specifi cally to pain.This study demonstrates that pain-related behavior in the acute postinfarction period is generally characterized by reduced mobility and explorative behavior. Our results showed that cardiac ischemia as a consequence of experimentally-induced infarction is a less important source of pain behavior than manipulation of the pericardium. (Int Heart J 2014; 55: 169-177) Key words: Pericardium, Postoperative pain, Behavior C hest pain is the primary and the most prominent symptom leading to the hospitalization of patients with the diagnosis of acute myocardial infarction (AMI). 1)These patients account for 20% of patients in medical emergency departments.2) However, chest pain related to AMI varies signifi cantly both in its intensity 3,4) and incidence. 5,6) In addition, the pain severity does not seem to be a good predictor of the outcome of myocardial infarction. 7)While the evaluation of pain in humans is predominantly based on conscious perception, in animals it relies mainly on behavioral output. 8) Defined by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience, 9) pain cannot be determined in animals, so proxy indicators are typically used. In order to increase the translational value of their studies, pain researchers working with experimental animals have focused more on complex behavioral responses and operant measures.10,11) Visceral pain models, eg, models of cardiac ischemia, delineate well these challenges. Pain elicited in these models is vague, with no specifi c region to focus pain measurements on, so broader behavioral and cognitive analysis is necessary to detect potential changes.12)The most commonly used stimuli i...

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“…13, 14 Beckett et al 15 demonstrated a similar benefit when the initial management of ACS occurred in an admission unit that was not exclusive for cardiac patients.…”

Section: Discussionmentioning

confidence: 88%