STUDY OBJECTIVE: To assess the safety and the accuracy of a 4 h stepwise diagnostic approach relying on clinical judgement in unselected patients with acute chest pain. DESIGN: Prospective cohort study. SETTING: Emergency department (ED) of a tertiary care university hospital. PATIENTS: 1288 unselected patients presenting with acute chest pain. INTERVENTIONS: After history and physical examination, clinical judgement (step I), governed the need for further patient evaluation: baseline 12 lead electrocardiogramm (ECG) and laboratory examinations (step II), serial 12 lead ECG and laboratory examinations after 4 h (step III), and 4 h troponin T measurement (step IV) to exclude or to confirm a coronary origin of chest pain. Patients were followed clinically for 6 months for future occurrence of cardiac events (myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA), CABG, cardiac death), any death and for accuracy of the ED diagnosis in non-coronary chest pain patients. MEASUREMENTS AND RESULTS: Chest pain was diagnosed to be coronary in origin in 381 and non-coronary in 907 patients, respectively. Cardiac events occurred during follow up in 240 (19%) of 1288 patients, in 233 of 381 (61%) with presumed coronary and seven of 907 (1%) with presumed non-coronary chest pain. Sensitivity, specificity, positive predictive value and negative predictive value for correct detection of coronary chest pain were 97, 86, 61 and 99%, respectively. In non-coronary chest pain patients the agreement between the ED diagnosis and the final diagnosis was good (kappa=0.71, 95% confidence interval (CI) 0.67-0.75). CONCLUSIONS: The 4 h stepwise approach guided by clinical judgement was safe for ruling out impending cardiac events in unselected patients with acute chest pain. However, more extensive evaluation is necessary for accurate rule-in of coronary chest pain.
STUDY OBJECTIVE: To assess the safety and the accuracy of a 4 h stepwise diagnostic approach relying on clinical judgement in unselected patients with acute chest pain. DESIGN: Prospective cohort study. SETTING: Emergency department (ED) of a tertiary care university hospital. PATIENTS: 1288 unselected patients presenting with acute chest pain. INTERVENTIONS: After history and physical examination, clinical judgement (step I), governed the need for further patient evaluation: baseline 12 lead electrocardiogramm (ECG) and laboratory examinations (step II), serial 12 lead ECG and laboratory examinations after 4 h (step III), and 4 h troponin T measurement (step IV) to exclude or to confirm a coronary origin of chest pain. Patients were followed clinically for 6 months for future occurrence of cardiac events (myocardial infarction, percutaneous transluminal coronary angioplasty (PTCA), CABG, cardiac death), any death and for accuracy of the ED diagnosis in non-coronary chest painpatients. MEASUREMENTS AND RESULTS:Chest pain was diagnosed to be coronary in origin in 381 and non-coronary in 907 patients, respectively. Cardiac events occurred during follow up in 240 (19%) of 1288 patients, in 233 of 381 (61%) with presumed coronary and seven of 907 (1%) with presumed non-coronary chest pain. Sensitivity, specificity, positive predictive value and negative predictive value for correct detection of coronary chest pain were 97, 86, 61 and 99%, respectively. In non-coronary chest painpatients the agreement between the ED diagnosis and the final diagnosis was good (kappa=0.71, 95% confidence interval (CI) 0.67-0.75). CONCLUSIONS: The 4 h stepwise approach guided by clinical judgement was safe for ruling out impending cardiac events in unselected patients with acute chest pain. However, more extensive evaluation is necessary for accurate rule-in of coronary chest pain.
Authors: John T Nagurney; David Frank Brown; Claudia Chae; YuChiao Chang; Won Chung; Hilarie Cranmer; Li Dan; Jonathan Fisher; Shamai Grossman; Usha Tedrow; Kent Lewandrowski; Ik-Kyung Jang Journal: J Thromb Thrombolysis Date: 2005-02 Impact factor: 2.300
Authors: Martin Schillinger; Gottfried Sodeck; Giora Meron; Karin Janata; Mariam Nikfardjam; Fritz Rauscha; Anton N Laggner; Hans Domanovits Journal: Wien Klin Wochenschr Date: 2004-02-16 Impact factor: 1.704
Authors: Christopher B Fordyce; C Larry Hill; Daniel B Mark; Brooke Alhanti; Patricia A Pellikka; Udo Hoffmann; Manesh R Patel; Pamela S Douglas Journal: Heart Date: 2022-05-12 Impact factor: 7.365