| Limitations of risk score models in patients with acute chest pain. | |
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MedLine Citation:
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PMID: 19041532 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Cardiac multidetector computed tomography (CMCT) has potential to be used as a screening test for patients with acute chest pain, but several tools are already used to risk-stratify this population. Risk models exist that stratify need for intensive care (Goldman), short-term prognosis (Thrombolysis in Myocardial Infarction, TIMI), and 1-year events (Sanchis). We applied these cardiovascular risk models to candidates for CMCT and assessed sensitivity for prediction of in-hospital acute coronary syndrome (ACS). We hypothesized that none of the models would achieve a sensitivity of 90% or greater, thereby justifying use of CMCT in patients with acute chest pain. METHODS: We analyzed TIMI, Goldman, and Sanchis in 148 consecutive patients with chest pain, nondiagnostic electrocardiogram, and negative initial cardiac biomarkers who previously met inclusion and exclusion criteria for the Rule-Out Myocardial Infarction Using Coronary Artery Tomography Study. ACS was adjudicated, and risk scores were categorized based on established criteria. Risk score agreement was assessed with weighted kappa statistics. RESULTS: Overall, 17 (11%) of 148 patients had ACS. For all risk models, sensitivity was poor (range, 35%-53%), and 95% confidence intervals did not cross above 77%. Agreement to risk-classify patients was poor to moderate (weighted kappa range, 0.18-0.43). Patients categorized as "low risk" had nonzero rates of ACS using all 3 scoring models (range, 8%-9%). CONCLUSIONS: Available risk scores had poor sensitivity to detect ACS in patients with acute chest pain. Because of the small number of patients in this data set, these findings require confirmation in larger studies. |
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Authors:
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Alex F Manini; Nina Dannemann; David F Brown; Javed Butler; Fabian Bamberg; John T Nagurney; John H Nichols; Udo Hoffmann; |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of emergency medicine Volume: 27 ISSN: 1532-8171 ISO Abbreviation: Am J Emerg Med Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-01 Completed Date: 2009-01-02 Revised Date: 2009-04-16 |
Medline Journal Info:
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Nlm Unique ID: 8309942 Medline TA: Am J Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 43-8 Citation Subset: IM |
Affiliation:
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Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine at Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. alex.manini@nyumc.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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complications,
diagnosis*,
radiography Adult Aged Chest Pain / etiology* Female Humans Male Middle Aged Myocardial Infarction / complications, diagnosis*, radiography Prognosis Prospective Studies Risk Assessment Risk Factors Severity of Illness Index* Tomography, X-Ray Computed |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL080053/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Am J Emerg Med. 2009 Mar;27(3):365-6; author reply 366-7
[PMID:
19328386
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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