Recognising acute coronary syndrome

Harskamp, Ralf E.; Fanaroff, Alexander C; Zhen, Sinead Wang; Sawe, Hendry R.; Weber, Ellen J

doi:10.1136/bmj-2021-069591

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…Despite continuous advances in diagnostic and therapeutic modalities, the mortality rate of acute coronary syndrome (ACS), has remained high over the past decades [ 1 , 2 ]. ACS encompasses a range of conditions that result from a sudden reduction in blood flow to the heart muscle and includes unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) [ 3 ]. Primary percutaneous coronary intervention (PCI) of the infarct-related artery reduces mortality and myocardial infarction in patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Albumin combined with neutrophil-to-lymphocyte ratio score and outcomes in patients with acute coronary syndrome treated with percutaneous coronary intervention

Wei,

Fan,

Zhang

et al. 2024

Coronary Artery Disease

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Background Evidence about the association between albumin combined with neutrophil-to-lymphocyte ratio score (ANS) and survival outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is rare. This study aimed to evaluate the prognostic value of ANS in patients with ACS undergoing PCI by propensity score matching (PSM) analysis. Patients and methods Patients with ACS undergoing PCI were consecutively enrolled in this prospective cohort study from January 2016 to December 2018. The albumin and neutrophil-to-lymphocyte ratio cutoff values for predicting major adverse cardiovascular events (MACEs) were calculated using receiver operating characteristic curves. Survival analysis was performed using Kaplan–Meier estimates, the Cox proportional hazard regression models and PSM. The study endpoint was the occurrence of a MACE, which included all-cause mortality and rehospitalization for severe heart failure during follow-up. Results Overall, 1549 patients with adequate specimens were identified and assigned into different groups for comparison. Before and after PSM, the Kaplan–Meier curves showed that a higher ANS value was associated with a higher risk of MACEs (all P < 0.001). The multivariate Cox proportional hazard regression model showed that the ANS (per 1 score increase) [hazard ratio (HR), 2.016; 95% confidence interval (CI), 1.329–3.057; P = 0.001 vs. HR, 2.166; 95% CI, 1.344–3.492; P = 0.002] was an independent predictor for MACEs. Conclusion This study tentatively confirms that ANS may be a valuable clinical indicator to identify high-risk ACS patients after PCI. More high-quality prospective studies are needed in the future.

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Section: Introductionmentioning

confidence: 99%

Albumin combined with neutrophil-to-lymphocyte ratio score and outcomes in patients with acute coronary syndrome treated with percutaneous coronary intervention

Wei,

Fan,

Zhang

et al. 2024

Coronary Artery Disease

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“…Understandably so, since missing an ACS may have serious consequences for the patient. 7 However, the spectrum of possible underlying conditions reaches far beyond ACS and includes several serious diagnoses that should not be overlooked (e.g. pulmonary embolism, aortic dissection, and sepsis).…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 5 , 6 , 8 Timely detection of these cases is vital in order to start adequate treatment to prevent complications, and even death. 7 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of telephone triage among chest pain patients in out-of-hours primary care in the Netherlands (TRACE)

et al. 2022

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Background Telephone triage is fully integrated in Dutch out-of-hours primary care (OOH-PC). Patients presenting with chest pain are initially assessed according to a standardized protocol (“Netherlands Triage Standard” [NTS]). Nevertheless, little is known about its (diagnostic) performance, nor on the impact of subsequent clinical judgements made by triage assistants and general practitioners (GPs). Objective To evaluate the performance of the current NTS chest pain protocol. Methods Observational, retrospective cohort study of adult patients with chest pain who contacted a regional OOH-PC facility in the Netherlands, in 2017. The clinical outcome measure involved the occurrence of a “major event,” which is a composite of all-cause mortality and urgent cardiovascular and noncardiovascular conditions, occurring ≤6 weeks of initial contact. We assessed the performance using diagnostic and discriminatory properties. Results In total, 1,803 patients were included, median age was 54.0 and 57.5% were female. Major events occurred in 16.2% of patients with complete follow-up, including 99 (6.7%) cases of acute coronary syndrome and 22 (1.5%) fatal events. NTS urgency assessment showed moderate discriminatory abilities for predicting major events (c-statistic 0.66). Overall, NTS performance showed a sensitivity and specificity of 83.0% and 42.4% with a 17.0% underestimated major event rate. Triage assistants’ revisions hardly improved urgency allocation. Further consideration of the clinical course following OOH-PC contact did generate a more pronounced improvement with a sensitivity of 89.4% and specificity of 61.9%. Conclusion Performance of telephone triage of chest pain appears moderate at best, with acceptable safety yet limited efficiency, even after including further work-up by GPs.

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“…One week later, in the issue of 7 May in an article intended to educate the readership on the importance of recognising acute coronary syndrome, the index case had the audacity to deny having chest pain 3. Fortunately, the healthcare professionals were astute enough to not be fooled by this denial and went on to diagnose a proximal left anterior descending artery occlusion, an intervention which is variably applied across healthcare settings leading to inequality of clinical outcomes, according to an article in the same edition of the journal 4…”

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confidence: 99%

The BMJ, look to your laurels to catalyse the patient revolution

Jones

2022

BMJ

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Recognising acute coronary syndrome

Cited by 5 publications

References 31 publications

Albumin combined with neutrophil-to-lymphocyte ratio score and outcomes in patients with acute coronary syndrome treated with percutaneous coronary intervention

Albumin combined with neutrophil-to-lymphocyte ratio score and outcomes in patients with acute coronary syndrome treated with percutaneous coronary intervention

Evaluation of telephone triage among chest pain patients in out-of-hours primary care in the Netherlands (TRACE)

The BMJ, look to your laurels to catalyse the patient revolution

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