Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room
Autor(a) principal: | |
---|---|
Data de Publicação: | 2000 |
Outros Autores: | , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Arquivos Brasileiros de Cardiologia (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000500002 |
Resumo: | PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI. |
id |
SBC-1_a1693a8b3914168f65b0ce512cd088f1 |
---|---|
oai_identifier_str |
oai:scielo:S0066-782X2000000500002 |
network_acronym_str |
SBC-1 |
network_name_str |
Arquivos Brasileiros de Cardiologia (Online) |
repository_id_str |
|
spelling |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency roomacute myocardial infarctionchest painemergency roomunstable anginaPURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI.Sociedade Brasileira de Cardiologia - SBC2000-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000500002Arquivos Brasileiros de Cardiologia v.74 n.5 2000reponame:Arquivos Brasileiros de Cardiologia (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.1590/S0066-782X2000000500002info:eu-repo/semantics/openAccessBassan,RobertoGamarski,RobertoPimenta,LúciaVolschan,AndréScofano,MarceloDohmann,Hans FernandoAraujo,MonicaClare,CristinaFabrício,MarceloSanmartin,Carlos HenriqueMohallem,KalilMacaciel,RenatoGaspar,Sergioeng2002-01-08T00:00:00Zoai:scielo:S0066-782X2000000500002Revistahttp://www.arquivosonline.com.br/https://old.scielo.br/oai/scielo-oai.php||arquivos@cardiol.br1678-41700066-782Xopendoar:2002-01-08T00:00Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC)false |
dc.title.none.fl_str_mv |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
title |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
spellingShingle |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room Bassan,Roberto acute myocardial infarction chest pain emergency room unstable angina |
title_short |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
title_full |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
title_fullStr |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
title_full_unstemmed |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
title_sort |
Efficacy of a diagnostic strategy for patients with chest pain and no ST-segment elevation in the emergency room |
author |
Bassan,Roberto |
author_facet |
Bassan,Roberto Gamarski,Roberto Pimenta,Lúcia Volschan,André Scofano,Marcelo Dohmann,Hans Fernando Araujo,Monica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Macaciel,Renato Gaspar,Sergio |
author_role |
author |
author2 |
Gamarski,Roberto Pimenta,Lúcia Volschan,André Scofano,Marcelo Dohmann,Hans Fernando Araujo,Monica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Macaciel,Renato Gaspar,Sergio |
author2_role |
author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Bassan,Roberto Gamarski,Roberto Pimenta,Lúcia Volschan,André Scofano,Marcelo Dohmann,Hans Fernando Araujo,Monica Clare,Cristina Fabrício,Marcelo Sanmartin,Carlos Henrique Mohallem,Kalil Macaciel,Renato Gaspar,Sergio |
dc.subject.por.fl_str_mv |
acute myocardial infarction chest pain emergency room unstable angina |
topic |
acute myocardial infarction chest pain emergency room unstable angina |
description |
PURPOSE: To evaluate the efficacy of a systematic model of care for patients with chest pain and no ST segment elevation in the emergency room. METHODS: From 1003 patients submitted to an algorithm diagnostic investigation by probability of acute ischemic syndrome. We analyzed 600 ones with no elevation of ST segment, then enrolled to diagnostic routes of median (route 2) and low probability (route 3) to ischemic syndrome. RESULTS: In route 2 we found 17% acute myocardial infarction and 43% unstable angina, whereas in route 3 the rates were 2% and 7%, respectively. Patients with normal/non--specific ECG had 6% probability of AMI whereas in those with negative first CKMB it was 7%; the association of the 2 data only reduced it to 4%. In patients in route 2 the diagnosis of AMI could only be ruled out with serial CKMB measurement up to 9 hours, while in route 3 it could be done in up to 3 hours. Thus, sensitivity and negative predictive value of admission CKMB for AMI were 52% and 93%, respectively. About one-half of patients with unstable angina did not disclose objective ischemic changes on admission. CONCLUSION: The use of a systematic model of care in patients with chest pain offers the opportunity of hindering inappropriate release of patients with ACI and reduces unnecessary admissions. However some patients even with normal ECG should not be released based on a negative first CKMB. Serial measurement of CKMB up to 9 hours is necessary in patients with medium probability of AMI. |
publishDate |
2000 |
dc.date.none.fl_str_mv |
2000-05-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000500002 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2000000500002 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/S0066-782X2000000500002 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia - SBC |
dc.source.none.fl_str_mv |
Arquivos Brasileiros de Cardiologia v.74 n.5 2000 reponame:Arquivos Brasileiros de Cardiologia (Online) instname:Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
instname_str |
Sociedade Brasileira de Cardiologia (SBC) |
instacron_str |
SBC |
institution |
SBC |
reponame_str |
Arquivos Brasileiros de Cardiologia (Online) |
collection |
Arquivos Brasileiros de Cardiologia (Online) |
repository.name.fl_str_mv |
Arquivos Brasileiros de Cardiologia (Online) - Sociedade Brasileira de Cardiologia (SBC) |
repository.mail.fl_str_mv |
||arquivos@cardiol.br |
_version_ |
1752126551267213312 |