Chest pain evaluation in the ED: Beyond triage

doi:10.1016/0735-6757(94)90219-4

The American Journal of Emergency Medicine

Volume 12, Issue 1, January 1994, Pages 121-122

https://doi.org/10.1016/0735-6757(94)90219-4 Get rights and content

References (10)

TH Lee et al.
Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room
Am J Cardiol
(1987)
RA Rusnak et al.
Litigation against the emergency physician: Common features in cases of missed myocardial infarction
Ann Emerg Med
(1989)
WB Gibler et al.
Early detection of acute myocardial infarction in patients presenting with chest pain and non-diagnostic ECGs: Serial CK-MB sampling in the emergency department
Ann Emerg Med
(1990)
L Graff et al.
Emergency department observation beds improve patient care: Society for Academic Emergency Medicine Debate
Ann Emerg Med
(1992)
GL Higgins et al.
Expediting the early hospital care of the adult patient with non-traumatic chest pain: Impact of a modified ED triage protocol
Am J Emerg Med
(1993)

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Cited by (22)

Endothelial function predicts 1-year adverse clinical outcome in patients hospitalized in the emergency department chest pain unit
2017, International Journal of Cardiology
Citation Excerpt :
The principal challenge in these patients is to identify those with coronary artery disease (CAD). Early diagnosis allows effective treatment, while premature discharge may have disastrous consequences for both patient and doctor: in the United States, between 2% and 5% of patients with acute myocardial infarctions are discharged from the ED, and 20% of malpractice claims against emergency physicians relate to the management of acute coronary syndrome [2]. Thus, a convenient non-invasive tool should useful to stratify the patients' risk.
Endothelial function is a marker for cardiovascular risk. Thus, abnormal endothelial function may be associated with adverse 1-year outcome in patients presenting to the emergency department chest pain unit (CPU).
Following endothelial function testing, using EndoPAT 2000 in 300 consecutive subjects with chest pain and no history of coronary artery disease (CAD) presenting to CPU, patients underwent coronary computerized tomographic angiography (CCTA) or single-photon emission computed tomography according to availability.
Mean 10-year Framingham risk score (FRS) was 6.6 ± 5.9%, median reactive hyperemia index (RHI) as a measure of endothelial function 2.08 and mean was 2.0 ± 0.4. During a 1-year follow-up, the 20 (6.6%) patients who developed major adverse cardiovascular end-points (MACE), including all-cause mortality, non-fatal myocardial infarction, hospitalization for heart failure or angina pectoris, stroke, coronary artery bypass grafting and percutaneous coronary interventions, had higher 10-year FRS (10.5 ± 8.2% vs 6.3 ± 5.7%; p < 0.001), lower baseline RHI (1.43 ± 0.41 vs 2.10 ± 0.44; p < 0.001) and a greater extent of coronary atherosclerosis lesions (70% vs 3.9%, p < 0.001) in the CPU CCTA, compared to those without MACE. RHI ≤ the median was associated with higher 1-year MACE (13% vs 0.7%, p < 0.001) compared to RHI > the median. Multivariate analysis demonstrated that RHI ≤ the median is an independent predictor of coronary atherosclerosis lesions in the CPU CCTA (OR 5.98, 95% CI 03.29-10.88; p < 0.001) and 1-year MACE (OR 15.207, 95% CI 2.00-115.33; p < 0.01).
Our findings suggest that non-invasive endothelial function testing may have clinical utility in triaging patients in the CPU and in predicting 1-year MACE.
Takotsubo syndrome and chest pain units
2013, American Journal of Emergency Medicine
2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/Non-ST-Elevation myocardial infarction: A report of the american college of cardiology Foundation/American Heart Association task force on practice guidelines
2013, Journal of the American College of Cardiology
Citation Excerpt :
Most strategies use a combination of cardiac biomarkers, short-term observation, diagnostic imaging, and provocative stress testing. An increasing number of high-quality centers now use structured protocols, checklists, or critical pathways to screen patients with suspected MI or UA (93–105). It does not appear to matter whether the institution designates itself a chest pain center; rather, it is the multifaceted, multidisciplinary, standardized, and structured approach to the problem that appears to provide clinical, cost-effective benefit (106,107).
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: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
2011, Journal of the American College of Cardiology
Citation Excerpt :
Most strategies use a combination of cardiac biomarkers, short-term observation, diagnostic imaging, and provocative stress testing. An increasing number of high-quality centers now use structured protocols, checklists, or critical pathways to screen patients with suspected MI or UA (87–99). It does not appear to matter whether the institution designates itself a chest pain center; rather, it is the multifaceted, multidisciplinary, standardized, and structured approach to the problem that appears to provide clinical, cost-effective benefit (100,101).
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...
2007, Journal of the American College of Cardiology
Citation Excerpt :
Most strategies use a combination of cardiac biomarkers, short-term observation, diagnostic imaging, and provocative stress testing. An increasing number of high-quality centers now use structured protocols, checklists, or critical pathways to screen patients with suspected MI or UA (87–99). It does not appear to matter whether the institution designates itself a chest pain center; rather, it is the multifaceted, multidisciplinary, standardized, and structured approach to the problem that appears to provide clinical, cost-effective benefit (100,101).
Point of care testing in the emergency department
2002, Journal of Emergency Medicine
Point of care (POC) testing in the Emergency Department (ED) is becoming more common. The implementation and maintenance of POC testing in the ED, however, is a complex issue. We performed a systematic review of the English language literature published between 1985 and June 2001 with a focus on POC testing and ED application. Articles that addressed the following were included in the review: implementation of POC testing, maintenance and regulation of POC testing, and application of POC testing. Current POC technology has been found to be reliable in various patient care settings, including the ED. Cost and connectivity issues are complex and difficult to assess, making these the greatest barriers to the full acceptance of POC testing in the ED. Patient care issues must be weighed against the cost of implementing POC testing and supporting the infrastructure needed to maintain this technology in the ED.

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EditorialChest pain evaluation in the ED: Beyond triage

Am J Cardiol

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med

Editorial
Chest pain evaluation in the ED: Beyond triage