Document Detail


Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the Emergency Department?
MedLine Citation:
PMID:  18691797     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the development of coronary artery disease. We sought to determine whether these traditional risk factors aid the diagnosis of acute myocardial infarction (AMI) in the Emergency Department (ED). METHODS: We performed a prospective diagnostic cohort study within the ED at Manchester Royal Infirmary, a university-affiliated teaching hospital with an annual ED census of approximately 145,000 patients. We recruited 804 patients who had presented to the ED with suspected cardiac chest pain. All patients had the presence or absence of traditional cardiac risk factors documented at the time of presentation using a custom-designed clinical report form. All patients subsequently underwent 12-h troponin T testing to provide a robust gold standard for the diagnosis of AMI according to revised World Health Organisation criteria. RESULTS: The absence of any traditional cardiac risk factors carried a negative likelihood ratio of 0.61 for the diagnosis of AMI. 12.2% of patients with no cardiac risk factors had AMI, compared with 21.3% of patients with four or five risk factors. The area under the receiver-operating characteristic curve was 0.49. CONCLUSIONS: Traditional cardiac risk factors are not helpful for the confirmation or exclusion of AMI within the ED. Future Emergency Medicine research should focus on those clinical and diagnostic features that are likely to alter during the acute phase of illness.
Authors:
Richard Body; Garry McDowell; Simon Carley; Kevin Mackway-Jones
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-08
Journal Detail:
Title:  Resuscitation     Volume:  79     ISSN:  0300-9572     ISO Abbreviation:  Resuscitation     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2009-01-27     Revised Date:  2009-08-25    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  41-5     Citation Subset:  IM    
Affiliation:
Emergency Medicine Research Group, Research Office, Emergency Department, Manchester Royal Infirmary, Manchester, United Kingdom. rbody@doctors.org.uk
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / complications*,  diagnosis*
Emergency Service, Hospital*
Female
Humans
Likelihood Functions
Logistic Models
Male
Middle Aged
Myocardial Infarction / diagnosis*,  etiology*
Prospective Studies
ROC Curve
Risk Factors
Comments/Corrections
Comment In:
Resuscitation. 2009 May;80(5):605   [PMID:  19278769 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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