دورية أكاديمية
أعرض في EDS

Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score.

التفاصيل البيبلوغرافية
العنوان: Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score.
المؤلفون: Abazid RM; Department of Medicine, Northern Ontario School of Medicine (NOSM) University, Sault Ste Marie, Ontario, Canada., Pati N; Department of Cardiology, Asian Institute of Gastroenterology (AIG) Hospitals, Gachibowli, Hyderabad, India.; Department of medicine, Dividion of Cardiology, London Health Sciences Centre, London, Ontario, Canada., Elrayes M; Department of medicine, Dividion of Cardiology, London Health Sciences Centre, London, Ontario, Canada., Awadallah S; Department of medicine, Dividion of Cardiology, London Health Sciences Centre, London, Ontario, Canada., Ibrahim MM; Department of Medicine, Northern Ontario School of Medicine (NOSM) University, Sudbury, Ontario, Canada., Alaref A; Department of Medicine, Northern Ontario School of Medicine (NOSM) University, Thunderbay, Ontario, Canada., Bureau Y; Department of Psychology, London Health Sciences Centre, London, Ontario, Canada., Akincioglu C; Department of Medical Imaging, Dividion of Nuclear Medicine, London Health Sciences Centre, London, Ontario, Canada., Bagur R; Department of medicine, Dividion of Cardiology, London Health Sciences Centre, London, Ontario, Canada., Tzemos N; Department of medicine, Dividion of Cardiology, London Health Sciences Centre, London, Ontario, Canada Niko.Tzemos@lhsc.on.ca.
المصدر: Open heart [Open Heart] 2024 Aug 25; Vol. 11 (2). Date of Electronic Publication: 2024 Aug 25.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101631219 Publication Model: Electronic Cited Medium: Print ISSN: 2053-3624 (Print) Linking ISSN: 20533624 NLM ISO Abbreviation: Open Heart Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group
مواضيع طبية MeSH: Emergency Service, Hospital* , Chest Pain*/diagnosis , Chest Pain*/etiology , Echocardiography, Stress*/methods, Humans ; Female ; Male ; Middle Aged ; Risk Assessment/methods ; Prospective Studies ; Aged ; Myocardial Perfusion Imaging/methods ; Risk Factors ; Prognosis ; Follow-Up Studies ; Predictive Value of Tests ; Electrocardiography ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/epidemiology ; Coronary Artery Disease/diagnostic imaging
مستخلص: Background: Patients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. The use of downstream non-invasive stress imaging (NISI) tests in this population remains uncertain. Therefore, this study aims to investigate the value of NISI in risk stratification and predicting cardiac events in patients with low-risk HEART scores (LRHSs).
Methods: We prospectively included 1384 patients with LRHSs between March 2019 and March 2021. All the patients underwent NISI (involving myocardial perfusion imaging/stress echocardiography). The primary endpoints included cardiac death, non-fatal myocardial infarction and unplanned coronary revascularisation. Secondary endpoints encompassed cardiovascular-related admissions or ED visits.
Results: The mean patient age was 64±14 years, with 670 (48.4%) being women. During the 634±104 days of follow-up, 58 (4.2%) patients experienced 62 types of primary endpoints, while 60 (4.3%) developed secondary endpoints. Multivariable Cox models, adjusted for clinical and imaging variables, showed that diabetes (HR: 2.38; p=0.008), HEART score of 3 (HR: 1.32; p=0.01), history of coronary artery disease (HR: 2.75; p=0.003), ECG changes (HR: 5.11; p<0.0001) and abnormal NISI (HR: 16.4; p<0.0001) were primary endpoint predictors, while abnormal NISI was a predictor of secondary endpoints (HR: 3.05; p<0.0001).
Conclusions: NISI significantly predicted primary cardiac events and cardiovascular-related readmissions/ED visits in patients with LRHSs.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
References: Am J Emerg Med. 2017 Jan;35(1):77-81. (PMID: 27765481)
Acad Emerg Med. 2019 Jan;26(1):41-50. (PMID: 29920834)
JAMA Cardiol. 2016 Apr 1;1(1):73-9. (PMID: 27437658)
Am J Cardiol. 2016 Dec 15;118(12):1786-1791. (PMID: 27865485)
Int J Cardiol. 2013 Oct 3;168(3):2153-8. (PMID: 23465250)
J Am Soc Echocardiogr. 2020 Jan;33(1):1-41.e8. (PMID: 31740370)
Eur Heart J Acute Cardiovasc Care. 2018 Mar;7(2):111-119. (PMID: 28534694)
J Nucl Cardiol. 2017 Dec;24(6):2064-2128. (PMID: 28916938)
Ann Intern Med. 2017 May 16;166(10):689-697. (PMID: 28437795)
Coron Artery Dis. 2017 Jun;28(4):336-341. (PMID: 28288007)
Ann Emerg Med. 2019 Aug;74(2):187-203. (PMID: 30718010)
Circulation. 2010 Oct 26;122(17):1756-76. (PMID: 20660809)
J Am Heart Assoc. 2021 Apr 6;10(7):e020082. (PMID: 33787290)
Crit Pathw Cardiol. 2016 Dec;15(4):145-151. (PMID: 27846006)
J Am Coll Cardiol. 2011 May 10;57(19):1920-59. (PMID: 21450428)
Eur Heart J Acute Cardiovasc Care. 2018 Oct;7(7):591-601. (PMID: 28361582)
Circulation. 2018 Nov 27;138(22):2456-2468. (PMID: 30571347)
CJC Open. 2023 Sep 07;5(12):891-903. (PMID: 38204849)
J Am Heart Assoc. 2019 Jun 18;8(12):e012542. (PMID: 31184243)
Intern Emerg Med. 2019 Jan;14(1):119-125. (PMID: 29845517)
Circulation. 2021 Nov 30;144(22):e368-e454. (PMID: 34709928)
فهرسة مساهمة: Keywords: Chest Pain; Echocardiography; Tomography, Emission-Computed, Single-Photon
تواريخ الأحداث: Date Created: 20240830 Date Completed: 20240830 Latest Revision: 20240904
رمز التحديث: 20240904
مُعرف محوري في PubMed: PMC11367375
DOI: 10.1136/openhrt-2024-002735
PMID: 39214533
قاعدة البيانات: MEDLINE
الوصف
تدمد:2053-3624
DOI:10.1136/openhrt-2024-002735