PMID: 9164374May 26, 1997Paper

An evaluation of a chest pain diagnostic protocol to exclude acute cardiac ischemia in the emergency department

Archives of Internal Medicine
R J ZalenskiM McDermott

Abstract

Although accelerated diagnostic protocols are being increasingly used in emergency departments to diagnose acute cardiac ischemia, there have been no prospective evaluations of a chest pain diagnostic protocol with serial determinations of creatine kinase MB isoenzyme and mandatory exercise electrocardiography (ExECG). Prospective cross-sectional study in which chest pain protocol results were compared with final (reference) diagnoses of acute cardiac ischemia (including acute myocardial infarction and unstable angina). Patients in need of hospital admission but at low probability (by a validated algorithm) for acute myocardial infarction were examined for exclusions: known coronary artery disease, cardiac complications, severe comorbidities, or inability to perform exercise testing. A 12-hour diagnostic protocol included serial measurements of creatine kinase MB, ECG, and clinical assessments followed by ExECG for those with negative initial serial testing. Reference diagnoses were established during hospitalization and diagnostic accuracy was assessed. The study group of 317 patients was 54% male and 65% black, and had a mean age of 46.6 years; 9.5% had a final diagnosis of acute cardiac ischemia. For this diagnosis, the prot...Continue Reading

Citations

Apr 20, 2001·Emergency Medicine Journal : EMJ·K R Herren, K Mackway-Jones
Jan 20, 1999·Journal of General Internal Medicine·R A KrasuskiK E Fleischmann
Jul 28, 2010·Circulation·Ezra A AmsterdamUNKNOWN American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology,
Mar 10, 2001·The American Journal of Medicine·E MartinezR R Roberts
Jun 17, 2011·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Jeremiah D SchuurBrent R Asplin
Jul 14, 2012·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Smitha R ChadagaEugene S Chu
Oct 31, 1998·Annals of Emergency Medicine·J LindsayE E Pinnow
Jul 24, 2008·AJR. American Journal of Roentgenology·Joseph A LadapoG Scott Gazelle
Feb 12, 2002·The American Journal of Medicine·Brendan M ReillyYue Wang
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Jul 25, 2012·Critical Pathways in Cardiology·Michael A RossCarol Clark

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