Document Detail


Exercise tolerance as a predictor of acute myocardial infarction in emergency department patients with potential acute coronary syndromes.
MedLine Citation:
PMID:  17933479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There is mounting evidence that exercise tolerance is an important predictor of heart disease. Our objective was to determine if decreased exercise tolerance, as estimated by physicians, may be useful in stratifying risk in Emergency Department (ED) patients with potential acute coronary syndromes. We conducted a prospective cohort study on a convenience sample of ED patients at an urban teaching hospital. Patients with chest pain, dyspnea, syncope, or epigastric pain who were evaluated for acute coronary syndromes were included. Clinical and laboratory data were recorded. In addition, the Emergency Physicians were asked to estimate the exercise tolerance of the patient as excellent, good, bad, or very poor. The primary outcome of the study was myocardial infarction (MI) or death in patients stratified by physician-perceived exercise tolerance (excellent or good vs. bad or very poor). There were 166 patients enrolled in the study. Nine patients (5%) had an MI; there were no deaths. Physicians reported exercise tolerance as excellent in 33 patients, good in 63, bad in 50, and very poor in 20. The unadjusted risk of MI was significantly elevated in patients with physician-perceived decreased exercise tolerance (relative risk = 4.8, 95% confidence interval 1.03-22). After adjustment for age, sex, and major cardiovascular risk factors, decreased exercise tolerance remained a significant predictor of MI (adjusted odds ratio = 7.3, 95% confidence interval 1.2-46). Exercise tolerance, as estimated by clinical impression, may be an important predictor of complications in ED patients presenting with potential acute coronary syndromes.
Authors:
Siu Fai Li; Kristine Samson; Maureen Bell; Wendy Whiteside; Michaella Okihara; Jonathan Prince; Veronica Kheyfets; Stephen Wall
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2007-10-15
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  36     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-26     Completed Date:  2009-05-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  8-11     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, Jacobi Medical Center, Bronx, New York 10461, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis*
Adult
Aged
Emergency Service, Hospital*
Exercise Tolerance*
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*
Odds Ratio
Pilot Projects
Predictive Value of Tests
Prospective Studies
Risk Factors

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


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