Document Detail

Limitations of clinical history for evaluation of patients with acute chest pain, non-diagnostic electrocardiogram, and normal troponin.
MedLine Citation:
PMID:  18308008     Owner:  NLM     Status:  MEDLINE    
Decision making and risk stratification for patients with acute chest pain, nondiagnostic electrocardiogram results, and normal troponin levels are challenging. The aim of this study was to optimize the clinical history for the evaluation of these patients. A total of 1,011 patients presenting to an emergency department were included. The following data were collected: clinical presentation (pain characteristics and number of pain episodes), coronary risk factors, previous ischemic heart disease, and extracardiac vascular disease (peripheral artery disease, stroke, or creatinine >1.4 mg/dl). Two different predictive models were calculated according to the end points: model 1 for 1-year major events (death or myocardial infarction) and model 2 for 30-day cardiac events (major events or revascularization). For 1-year major events, model 1 showed optimal discrimination capacity (C statistic = 0.80), which was significantly better than that of model 2 (C statistic = 0.77, p = 0.04). With respect to 30-day cardiac events, however, discrimination was lower in the 2 models, without differences between them (C statistic = 0.74 vs 0.75, p = NS). Using model 1, a large low-risk subgroup with <3 predictive variables could be defined, including 442 patients (44% of the total population) with a 1.4% rate of 1-year major events; however, the incidence of 30-day cardiac events (8%) was not negligible, mainly because of revascularizations. In conclusion, in patients with acute chest pain of uncertain coronary origin, clinical predictive models afford good risk stratification for long-term major events. Short-term outcomes, including revascularization, however, are not predicted as well. Therefore, ancillary tools, such as noninvasive stress tests, should be implemented for decision making at initial hospitalization or discharge.
Juan Sanchis; Vicent Bodí; Julio Núñez; Xavier Bosch; Pablo Loma-Osorio; Luis Mainar; Enrique Santas; Gema Miñana; Rocío Robles; Angel Llàcer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-12-21
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-29     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  613-7     Citation Subset:  AIM; IM    
Servei de Cardiologia, Hospital Clínic Universitari, Universitat de València, València, Spain.
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MeSH Terms
Acute Disease
Age Factors
Chest Pain / epidemiology*
Creatinine / blood
Diabetes Mellitus / epidemiology
Emergency Service, Hospital
Exercise Test
Hospitalization / statistics & numerical data
Middle Aged
Models, Cardiovascular*
Myocardial Infarction / epidemiology
Myocardial Ischemia / epidemiology
Myocardial Revascularization / statistics & numerical data
Peripheral Vascular Diseases / epidemiology
Regression Analysis
Risk Assessment
Risk Factors
Sex Factors
Stroke / epidemiology
Troponin I / blood*
Reg. No./Substance:
0/Troponin I; 60-27-5/Creatinine

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