| Predictors of 30-day Cardiovascular Events in Patients With Prior Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting. | |
| | |
MedLine Citation:
|
PMID: 21676059 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
ACADEMIC EMERGENCY MEDICINE 2011; 18:613-618 © 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives: Risk stratification of patients with potential acute coronary syndrome (ACS) is difficult. Patients with prior revascularization are considered higher risk, but they can also have symptoms from noncardiac causes. This study evaluated whether the presenting clinical characteristics were predictive of an increased risk of 30-day cardiovascular events in patients with prior revascularization presenting to the emergency department (ED) with symptoms of potential ACS. Methods: This was a secondary analysis of the DISPO-ACS study, a 2000-patient, four-site, randomized controlled trial of patients presenting with potential ACS. Process outcomes were evaluated using point-of-care cardiac markers compared to standard laboratory-based markers. Data included demographics, history, presenting symptoms, laboratory and electrocardiogram (ECG) results, hospital course, and 30-day cardiovascular events (death, acute myocardial infarction [AMI], revascularization). The association between presenting characteristics and 30-day cardiovascular events was assessed using univariable analysis and logistic regression; odds ratios (ORs) with 95% confidence intervals (CIs) are given. Results: Of 2,000 patients enrolled, 611 had prior revascularization (538 percutaneous coronary intervention [PCI], 232 coronary artery bypass graft [CABG], 159 both). The mean (±SD) age was 66 (±14) years, 44% were female, and 22% were black. By 30 days, 101 patients (17%) had cardiovascular events (81 during the index visit, 20 during follow-up). There were four deaths, 28 AMIs, and 67 revascularizations within 30 days; 20 patients had multiple endpoints. Being male (OR = 1.67, 95% CI = 1.07 to 2.62) or nonblack (OR = 1.95, 95% CI = 1.07 to 3.56) or having a family history of coronary artery disease (CAD; OR = 2.09, 95% CI = 1.32 to 3.3), elevated lipids (OR = 1.71, 95% CI = 1.04 to 2.82), prior AMI (OR = 1.79, 95% CI = 1.16 to 2.76), abnormal ECG on arrival (OR = 2.1, 95% CI = 1.33 to 3.34), and a positive initial troponin (OR = 14.7, 95% CI = 6.8 to 32.2) were predictive of cardiovascular events. The multivariable model found family history of CAD (OR = 2.06, 95% CI = 1.26 to 3.36), abnormal initial ECG (OR = 1.89, 95% CI = 1.16 to 3.09), and positive initial troponin (OR = 13.3, 95% CI = 5.9 to 29.6) remained predictive of 30-day cardiovascular events. Conclusions: In patients with prior revascularization, the initial ECG and early cardiac marker elevations, but not clinical presentation, predict odds of 30-day death, AMI, or revascularization. |
| | |
Authors:
|
Emily C Esposito; Judd E Hollander; Richard J Ryan; Donald Schreiber; Brian O'Neil; Raymond Jackson; Robert Christenson; W Brian Gibler; Christopher J Lindsell |
Related Documents
:
|
8261479 - Aortic dissection due to discontinuation of beta-blocker therapy. 21665919 - Risk markers of late high-degree atrioventricular block in patients with left ventricul... 6142449 - Pirbuterol hydrochloride: evaluation of beta adrenergic agonist activity in reversible ... 22356569 - Lactate clearance in cardiogenic shock following st elevation myocardial infarction: a ... 1378149 - Use of multiple-action agents on the heart: pathophysiological and therapeutic consider... 22156269 - β-blockade in the perioperative management of the patient with cardiac disease undergo... 187309 - Pathology of the heart in friedreich's ataxia: review of the literature and report of o... 8261479 - Aortic dissection due to discontinuation of beta-blocker therapy. 21928199 - Echocardiographic quantitative analysis of resting myocardial function for the assessme... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 18 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2011 Jun |
Date Detail:
|
Created Date: 2011-06-16 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
|
Languages: eng Pagination: 613-8 Citation Subset: IM |
Copyright Information:
|
© 2011 by the Society for Academic Emergency Medicine. |
Affiliation:
|
From the Department of Emergency Medicine, University of Pennsylvania (ECE, JEH), Philadelphia, PA; the Department of Emergency Medicine, University of Cincinnati (RJR, WBG, CJL), Cincinnati, OH; the Department of Emergency Medicine, William Beaumont Hospital (BO, RJ), Royal Oak, MI; the Division of Emergency Medicine, Stanford University (DS), Stanford, CA; and the Department of Pathology, University of Maryland (RC), Baltimore, MD. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Pediatric emergency health care providers' knowledge, attitudes, and experiences regarding emergency...
Next Document: Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target ...