Document Detail

Early echocardiography can predict cardiac events in emergency department patients with chest pain.
MedLine Citation:
PMID:  9581137     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: Accurate diagnosis in emergency department patients with possible myocardial ischemia is problematic. Two-dimensional echocardiography has a high sensitivity for identifying patients with myocardial infarction (MI); however, few studies have investigated its diagnostic ability when used acutely in ED patients with possible myocardial ischemia. Therefore we investigated the ability of ED echocardiography for predicting cardiac events in patients with possible myocardial ischemia. METHODS: Echocardiography was performed within 4 hours of ED presentation in 260 patients with possible myocardial ischemia, and was considered positive if there were segmental wall motion abnormalities or the ejection fraction was less than 40%. ECGs were considered abnormal if there was an ST-segment elevation or depression of greater than or equal to 1 mm, or ischemic T-wave inversion. Cardiac events included MI and revascularization. RESULTS: Of the 260 patients studied, 45 had cardiac events (23 MI, 19 percutaneous transluminal angioplasty, 3 coronary bypass surgery). The sensitivity of echocardiography for predicting cardiac events was 91% (95% confidence interval 79% to 97%]), which was significantly higher than the ECG (40% [95% CI 27% to 55%]: P < .0001), although specificity was lower (75% [95% CI 69% to 81%] versus 94% [95% CI 90% to 97%]; P < .001). Addition of the echocardiography results to baseline clinical variables and the ECG added significant incremental diagnostic value (P < .001). With use of multivariate analysis, only male gender (P < .03, odds ratio [OR] 2.4 [1.1 to 5.3]), and a positive echocardiographic finding (P < .0001, OR 24 [9 to 65]) predicted cardiac events. Excluding patients with abnormal ECGs (N = 30) did not affect sensitivity (85%) or specificity (74%) of echocardiography. CONCLUSION: Echocardiography performed in ED patients with possible myocardial ischemia identifies those who will have cardiac events, is more sensitive than the ECG, and has significant incremental value when added to baseline clinical variables and the ECG.
M C Kontos; J A Arrowood; W H Paulsen; J V Nixon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  31     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1998 May 
Date Detail:
Created Date:  1998-05-22     Completed Date:  1998-05-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  550-7     Citation Subset:  AIM; IM    
Department of Internal Medicine (Cardiology), Medical College of Virginia Hospitals/Virginia Commonwealth University, Richmond, USA.
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MeSH Terms
Chest Pain / etiology*
Echocardiography / standards
Emergency Service, Hospital
Follow-Up Studies
Middle Aged
Multivariate Analysis
Myocardial Ischemia / complications*,  physiopathology,  ultrasonography*
Reproducibility of Results
Sensitivity and Specificity
Stroke Volume
Time Factors

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

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