Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction

Hedges, Jerris R.; Young, Gary P.; Henkel, Gary F.; Gibler, W. Brian; Green, Terrence R.; Swanson, J. Robert

doi:10.1016/s0196-0644(05)80057-5

Cited by 103 publications

(43 citation statements)

References 22 publications

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“…5,6 Although risk prediction algorithms such as the acute cardiac ischemia time-insensitive predictive instrument 7 have improved the ability to risk stratify patients, the threshold to admit chest pain patients remains low.…”

mentioning

confidence: 99%

Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain

et al. 2006

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Background-Noninvasive assessment of coronary atherosclerotic plaque and significant stenosis by coronary multidetector computed tomography (MDCT) may improve early and accurate triage of patients presenting with acute chest pain to the emergency department. Methods and Results-We conducted a blinded, prospective study in patients presenting with acute chest pain to the emergency department between May and July 2005 who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice MDCT coronary angiography was performed immediately before admission, and data sets were evaluated for the presence of coronary atherosclerotic plaque and significant coronary artery stenosis. All providers were blinded to MDCT results.

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confidence: 99%

Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain

et al. 2006

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“…175,208 Although serial ECGs increase the ability to diagnose UA and MI, 208 -212 the yield is higher with serial cardiac biomarker measurements. [212][213][214] However, identification of new injury on serial 12-lead ECG (and not elevated cardiac biomarkers) is the principal eligibility criterion for emergency reperfusion therapy, so that monitoring of both is recommended. Continuous 12-lead ECG monitoring to detect ST-segment shifts, both symptomatic and asymptomatic, also can be performed with microprocessor-controlled programmable devices.…”

Section: Electrocardiogrammentioning

confidence: 99%

“…An injury current was detected in an additional 16% of chest pain patients in 1 study. 213 The identification of ischemic ECG changes on serial or continuous ECG recordings frequently alters therapy and provides independent prognostic information. 212,215,216…”

Section: Electrocardiogrammentioning

confidence: 99%

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson¹,

Adams²,

Antman³

et al. 2011

Circulation

683

367

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“…Two studies indicated that diagnostic accuracy of the prehospital ECG can be improved by repeating the ECG on arrival in the ED and by serial measurement of cardiac markers (LOE D2). 109,110 Two studies showed that computer-interpreted electrocardiograpy or field-transmitted electrocardiography can be applied if no adequate interpretation of the prehospital ECG is available on site (LOE D1 111,112 ). …”

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confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction

Cited by 103 publications

References 22 publications

Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain

Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Part 9: Acute Coronary Syndromes

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