دورية أكاديمية
Early stratification of patients with chest pain and suspected acute coronary syndrome in the Emergency Department.
| العنوان: | Early stratification of patients with chest pain and suspected acute coronary syndrome in the Emergency Department. |
|---|---|
| المؤلفون: | Bracco C; Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy., Melchio R, Sturlese U, Pomero F, Martini G, Poggi A, Cena P, Severini S, Castagna E, Brignone C, Serraino C, Dutto L, Veglio F, Fenoglio L |
| المصدر: | Minerva medica [Minerva Med] 2010 Apr; Vol. 101 (2), pp. 73-80. |
| نوع المنشور: | Evaluation Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Edizioni Minerva Medica Country of Publication: Italy NLM ID: 0400732 Publication Model: Print Cited Medium: Print ISSN: 0026-4806 (Print) Linking ISSN: 00264806 NLM ISO Abbreviation: Minerva Med Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Torino : Edizioni Minerva Medica |
| مواضيع طبية MeSH: | Acute Coronary Syndrome/*diagnosis , Chest Pain/*etiology , Critical Pathways/*standards , Myocardial Infarction/*diagnosis, Acute Coronary Syndrome/physiopathology ; Adult ; Aged ; Angina, Unstable/diagnosis ; Area Under Curve ; Biomarkers/blood ; Chest Pain/physiopathology ; Chest Pain/therapy ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/therapy ; Diagnosis, Differential ; Electrocardiography ; Emergency Service, Hospital ; Female ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Myocardial Infarction/therapy ; Myocardial Revascularization/methods ; Myocardial Revascularization/statistics & numerical data ; ROC Curve ; Risk Factors |
| مستخلص: | Aim: The aim of this study was to investigate the accuracy of a critical pathway in the early stratification and management of patients with chest pain and suspected acute coronary syndrome (ACS) in the Emergency Department (ED). Methods: An observational study was performed enrolling all patients with non-traumatic chest pain and suspected ACS who presented during a one-year period in the ED, where a critical pathway with five-level risk stratification, based on risk factors, characteristics of pain and ECG, was implemented. Patients were prospectively evaluated for rates of death, unstable angina, myocardial infarction or revascularization procedure occurring during admission or in the 30 days following discharge from the ED. Receiver-Operating Characteristics (ROC) curve was used to measure the accuracy of the stratification method. Results: Overall, 1813 patients were enrolled: 475 patients (26.1%, 95% CI: 24.0-28.1 ) were admitted and 1338 (73.8%, 95% CI: 71.7-75.8) were discharged. Main outcomes occurred in 233 (49.9%, 95% CI: 47.5-52.2) of patients admitted and in 6 (0.4%, 95% CI: 0.06-0.7) of those discharged. The risk stratification system showed a good accuracy with an AUC-ROC curve of 0.90 (95% CI: 0.88-0.93). A total of 1541 (85%) patients were managed according to critical pathway. Adverse events were significantly fewer in patients discharged according to pathway criteria than in those who were not (0.27% vs. 1.37%, difference: 1.1% CI 95%: 0.06-2.1), without significant increase of inappropriate admissions. Conclusion: A critical pathway, based on clinical and ECG features, is a safe and accurate tool to stratify and manage the patients with non-traumatic chest pain and suspected ACS in the ED. |
| التعليقات: | Comment in: Minerva Med. 2010 Oct;101(5):371-2. (PMID: 21048558) |
| المشرفين على المادة: | 0 (Biomarkers) |
| تواريخ الأحداث: | Date Created: 20100515 Date Completed: 20100816 Latest Revision: 20191210 |
| رمز التحديث: | 20240513 |
| PMID: | 20467407 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 0026-4806 |
|---|