Critical pathways in cardiology
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Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. ⋯ Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates.
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Emergency department observation units (EDOUs) serve an important role in the evaluation and risk stratification of low-risk chest pain patients. ⋯ In conclusion, intermediate-risk chest pain patients in an EDOU had higher rates of significant cardiac events and inpatient admission. Intermediate-risk patients may be appropriate for EDOU placement, given the acceptable inpatient admission rate and the lack of significant adverse events in the 30-day follow-up period. However, given the higher rate of significant cardiac events, the results of our study emphasize the need for increased vigilance and close cardiology consultation in the intermediate-risk group.
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Role of biomarkers in ST-segment elevation myocardial infarction (STEMI) is paramount, as they aid in diagnosis and gauge prognosis of the disease. In this project, we sought to study the short-term outcome and clinical associates of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the setting of STEMI at a tertiary center in India. ⋯ The data suggest that women are more likely to have increased NT-proBNP while presenting with STEMI. Duration of chest pain and age at presentation are the best predictors of elevated NT-proBNP, though without much bearing on short-term morbidity and mortality.
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Comparative Study
Can the HEART score safely reduce stress testing and cardiac imaging in patients at low risk for major adverse cardiac events?
Patients with low-risk chest pain have high utilization of stress testing and cardiac imaging, but low rates of acute coronary syndrome (ACS). The objective of this study was to determine whether the HEART score could safely reduce objective cardiac testing in patients with low-risk chest pain. ⋯ If used to guide stress testing and cardiac imaging, the HEART score could substantially reduce cardiac testing in a population with low pretest probability of ACS.
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Comparative Study
Comparison of cardiac risk scores in ED patients with potential acute coronary syndrome.
: The ability to risk stratify patients presenting to the emergency department (ED) with potential acute coronary syndrome (ACS) is critical. Several risk scores for patients with definite ACS have been developed, but only the TIMI risk score has been shown to risk stratify ED patients with potential ACS. We compared the prognostic value of the GRACE and PURSUIT risk scores to the TIMI score in the broader ED patient population presenting with potential ACS. ⋯ : In this large cohort of ED patients, the TIMI risk score had the best discriminatory ability to predict 30-day cardiovascular events.