Document Detail


Predictors of revascularization among emergency department patients who are evaluated for acute coronary syndrome.
MedLine Citation:
PMID:  15976966     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To determine, among patients who present to the emergency department with symptoms suggestive of acute coronary syndrome (ACS), predictors of short-term revascularization. METHODS: A prospective descriptive trial was performed. Potential predictors for revascularization were measured by means of a questionnaire of providers, serum for cardiac biomarkers, and an initial ECG. The primary outcome of revascularization (coronary bypass graft or percutaneous intervention) was determined through a medical record review. Potential predictors of revascularization were entered into a family of logistic regressions. RESULTS: 341 eligible subjects were enrolled, of whom 14% underwent revascularization. The predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization. CONCLUSION: In a single site study, among emergency department patients with symptoms suggestive of ACS, ST elevation on initial ECG and an elevation in troponin I, CK-MB, and myoglobin upon presentation all predicted short -term revascularization. Among the three biomarkers, elevation in troponin I was the strongest predictor. ABBREVIATED ABSTRACT: We conducted a prospective descriptive trial to identify predictors of short-term revascularization among 341 emergency department patients who presented with symptoms suggestive of ACS. Fourteen percent of the study population received revascularization. Predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0.), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization.
Authors:
John T Nagurney; David Frank Brown; Claudia Chae; YuChiao Chang; Won Chung; Hilarie Cranmer; Li Dan; Jonathan Fisher; Shamai Grossman; Usha Tedrow; Kent Lewandrowski; Ik-Kyung Jang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  19     ISSN:  0929-5305     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2005-09-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  41-6     Citation Subset:  IM    
Affiliation:
Massachusetts General Hospital, Clinics 115, 55 Fruit Street, Boston, MA 02114, USA. Nagurney.john@mgh.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Bypass
Coronary Disease / epidemiology,  surgery*,  therapy*
Female
Humans
Male
Middle Aged
Myocardial Revascularization*
Predictive Value of Tests
Prospective Studies
Questionnaires
Risk Factors
Treatment Outcome

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


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