Acute Coronary Syndrome Chest Pain Research Articles

35 Comparison of the heart and grace risk stratification tools in predicting significant coronary artery disease in patients presenting with non acs chest pain to the emergency department: Abstract 35 Table 1

Introduction Chest pain is one of the most common presenting complaints in the Emergency Department (ED) accounting for approximately 10% of total ED visits. Clinicians are often challenged in differentiating chest pain associated with significant coronary artery disease (CAD) from non-significant. Both HEART score and GRACE score are often used to risk stratify patients with chest pain in ED. No study has previously compared the two scores in prediction of the presence of significant CAD in a non ACS (Acute Coronary Syndrome) population. Objective To compare the HEART score with the GRACE score amongst non ACS chest pain patients discharged from ED to chest pain clinic follow up with a confirmed diagnosis of CAD. Method Retrospective analysis of data collected by the specialist cardiology nurse on non ACS chest pain patients who attended the chest pain clinic from April 2014 to December 2014. Age, gender, detailed history, risk factors, ECG, and high sensitivity troponin were collected. Both HEART score and GRACE scores were calculated on each patient and stratified into low, intermediate and high risk of MACE in both indexes. Presence of CAD was confirmed or excluded by either visual coronary angiography or CT coronary angiography. Primary end point is the evidence of significant coronary artery disease needing medical treatment or angioplasty. Result A total of 177 out of 403 patients had CT coronary angiography or coronary angiography performed, results available on 111 patients. Mean age was 58.79 ± 10.98 years. 40.54% (n = 45) male and female 59.45% (n = 66). A total of 69.36% (n = 77) patients had coronary angiogram while 30.63% (n = 34) had CT coronary angiogram. Heart score was found to be more sensitive and specific than GRACE; High risk 100% vs 50% (p Conclusion In this study the HEART score has shown to be a statistically significant predictor for the diagnosis or exclusion of CAD when compared to the GRACE score. As a result it is the preferred risk stratification tool for the everyday evaluation of patients who present to Tallaght Hospital ED with chest pain.

An online tool for nurse triage to evaluate risk for acute coronary syndrome at emergency department.

Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

Diagnostic performance and cost of CT angiography versus stress ECG — A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE)

BackgroundCoronary CT angiography (CCTA) has high sensitivity, with 3 recent randomized trials favorably comparing CCTA to standard-of-care. Comparison to exercise stress ECG (ExECG), the most available and least expensive standard-of-care worldwide, has not been systematically tested. MethodsCT-COMPARE was a randomized, single-center trial of low–intermediate risk chest pain subjects undergoing CCTA or ExECG after the first negative troponin. From March 2010 to April 2011, 562 patients randomized to either dual-source CCTA (n=322) or ExECG (n=240). Primary endpoints were diagnostic performance for ACS, and hospital cost at 30days. Secondary endpoints were time-to-discharge, admission rates, and downstream resource utilization. ResultsACS occurred in 24 (4%) patients. ExECG had 213 negative studies and 27 (26%) positive studies for ACS with sensitivity of 83% [95% CI: 36, 99.6%], specificity of 91% [CI: 86, 94%], and ROC AUC of 0.87 [CI: 0.70, 1]. CCTA (>50% stenosis considered positive) had 288 negative studies and 18/35 (51%) positive studies with a sensitivity of 100% [CI: 81.5, 100], specificity of 94% [CI: 91.2, 96.7%], and ROC of 0.97 [CI: 0.92, 1.0; p=0.2]. Despite CCTA having higher odds of downstream testing (OR 2.0), 30day per-patient cost was significantly lower for CCTA ($2193 vs $2704, p<0.001). Length of stay for CCTA was significantly reduced (13.5h [95% CI: 11.2–15.7], ExECG 19.7h [95% CI: 17.4–22.1], p<0.0005), which drove the reduction in cost. No patient had post-discharge cardiovascular events at 30days. ConclusionsCCTA had improved diagnostic performance compared to ExECG, combined with 35% relative reduction in length-of-stay, and 20% reduction in hospital costs. These data lend further evidence that CCTA is useful as a first line assessment in emergency department chest pain.

O078 Diagnostic Accuracy of CT Angiography vs Stress ECG in a Large Randomized Prospective Study of Suspected Acute Coronary Syndrome Chest Pain in the ED - “CTCOMPARE”

O078 Diagnostic Accuracy of CT Angiography vs Stress ECG in a Large Randomized Prospective Study of Suspected Acute Coronary Syndrome Chest Pain in the ED - “CTCOMPARE”

N-Terminal Pro B-Type Natriuretic Peptide Identifies Patients with Chest Pain at High Long-term Cardiovascular Risk

Background Little is known about the long-term prognostic value of N-terminal pro B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) in low-risk patients with chest pain. Methods Between June 1997 and January 2000, a standard rule-out protocol was performed in patients presenting to the emergency department within 6 hours of onset of chest pain with a normal or nondiagnostic electrocardiogram (ECG) on admission at the Academic Medical Center Amsterdam, VU University Medical Center Amsterdam and Medical Center Alkmaar, The Netherlands. Patients with acute coronary syndrome were identified by troponin T, recurrent angina, and serial ECGs. CRP and NT-proBNP on admission were measured using standardized methods. Results A total of 524 patients were included (145 with acute coronary syndrome and 379 with rule-out acute coronary syndrome). Long-term follow-up was successfully carried out in 96% of the study population. Death occurred in 78 patients (15%), 43 (11%) in the rule-out acute coronary syndrome group and 35 (24%) in the acute coronary syndrome group ( P < .001). In the rule-out acute coronary syndrome group, 21 patients (42%) died of a cardiovascular cause compared with 24 patients (69%) in the acute coronary syndrome group ( P < .001). In multivariate Cox regression analysis, age more than 65 years, previous myocardial infarction, known chronic heart failure, a nondiagnostic ECG on admission, and elevated NT-proBNP levels (>87 pg/mL, as derived from the receiver operating characteristic curve) were independent predictors of long-term cardiovascular mortality in the rule-out acute coronary syndrome group. In the acute coronary syndrome group, these predictors were age more than 65 years, documented coronary artery disease, and elevated NT-proBNP levels. Elevated levels of CRP were an independent predictor for cardiovascular mortality in patients with rule-out acute coronary syndrome at 3-year follow-up only. In patients with rule-out acute coronary syndrome with normal CRP and NT-proBNP levels, the cardiovascular mortality incidence rate was 4.7 per 1000 person-years, compared with a death rate of 20 in patients with both biomarkers elevated, which was comparable to the 17.9 per 1000 person-years incidence rate in patients with acute coronary syndrome. Conclusion A positive biomarker panel discriminates patients with rule-out acute coronary syndrome chest pain with a normal or nondiagnostic ECG who have a high risk for long-term cardiovascular mortality.