| A 2-hour thrombolysis in myocardial infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: Comparison of chest pain risk stratification tools. | |
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MedLine Citation:
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PMID: 23067909 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Accelerated diagnostic pathways for risk stratification of patients presenting to the emergency department with potential acute coronary syndromes may identify very-low-risk patients safe for early discharge to outpatient care. METHODS: Patients presenting with potential acute coronary syndrome to the emergency department were prospectively enrolled between November 2007 and April 2010. Patient characteristics in conjunction with 0- and 2-hour biomarkers and electrocardiograms were analyzed according to a 2-hour thrombolysis in myocardial infarction (TIMI) score and 9 other accelerated diagnostic pathways. The primary outcome was acute coronary syndrome by 30 days. RESULTS: Of 1,000 patients, 362 (36.2%) had a primary outcome. A pathway comprising electrocardiogram, prior ischemic heart disease, 0/2-hour troponin/creatine kinase MB fraction/myoglobin identified the highest proportion (25.0%) as low risk, with 96.1% sensitivity for the primary outcome. A pathway comprising electrocardiogram, history of ischemic heart disease, typical vs atypical symptoms, 0/2-hour troponin was the safest, with 99.7% sensitivity for the primary outcome, but only 9.0% were low risk. A pathway comprising the TIMI score with 0/2-hour troponin and electrocardiograms identified 15.5% as low risk, with a sensitivity of 99.2% for the primary outcome. This compares with standard care in which none were for outpatient care but, 3.3% had a primary outcome postdischarge within 30 days. CONCLUSION: In this relatively high-risk population, a 2-hour TIMI score safely identified significant numbers of patients suitable for early discharge to outpatient care. |
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Authors:
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Sally J Aldous; Mark Richards; Louise Cullen; Richard Troughton; Martin Than |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: American heart journal Volume: 164 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2012 Oct |
Date Detail:
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Created Date: 2012-10-16 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 516-23 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Mosby, Inc. All rights reserved. |
Affiliation:
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Christchurch Hospital, Christchurch, New Zealand. Electronic address: sally.aldous@cdhb.govt.nz. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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