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Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

World Journal of Cardiology 2017年第3期9卷 241-247页

作者： Cláudio Marcelo Bittencourt das Virgens Laudenor Lemos Jr Márcia Noya-Rabelo Manuela Campelo Carvalhal Antonio Maurício dos Santos Cerqueira Junior Fernanda Oliveira de Andrade Lopes Nicole Cruz de Sá Jéssica Gonzalez Suerdieck Thiago Menezes Barbosa de Souza Vitor Calixto de Almeida Correia Gabriella Sant’Ana Sodré AndréBarcelos da Silva Felipe Kalil Beirao Alexandre Felipe Rodrigues Marques Ferreira Luís Cláudio Lemos Correia Department of Cardiology Hospital Sao Rafael Department of Cardiology Hospital Português Bahiana School of Medicine and Public Health

AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest *** We studied individuals who were consecutively admitted to our chest pain *** admission,investigators performed a standardized interview and recorded14 chest pain *** on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and *** the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to *** order to assess reproducibility,a second cardiologist did the same *** In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of ***,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

关键词： acute chest pain Clinical judgment Gestalt Coronary artery disease acute coronary syndrome

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The early risk stratification of the patients with acute chest pain

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Journal of Nanjing Medical University 2007年第6期21卷 363-366页

作者： Chunping Tang Yanrong Liu Qin Shen Zhijian Yang Jun Huang Ming Gui chest pain Emergency Department the First Affiliated Hospital of Nanjing Medical University＇ Nanjing 210029 Jiangsu Province China

Objective： This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram （ECG）, cardiac injury markers and the number of accompanying traditional risk factors（smoking, obesity, hyperlipemia, hypertension, diabetes）, and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods： We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome（ACS） admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram （ECG）, cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups： Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes（without abnormal cardiac injury biomarkers）. Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and 〉2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only ≤ 2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results：After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS（the specificity being 90.7%）. The mortality of group 3 was higher compared with group 4（69.6% vs 53.3%）, however the P value was more than 0.05 and didn＇ t show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation （r= 0.202, P = 0.044） with

关键词： acute chest pain risk stratification ECG cardiac injury markers

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SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit

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World Journal of Cardiology 2022年第8期14卷 454-461页

作者： Daniel Antwi-Amoabeng Chanwit Roongsritong Moutaz Taha Bryce David Beutler Munadel Awad Ahmed Hanfy Jasmine Ghuman Nicholas T Manasewitsch Sahajpreet Singh Claire Quang Nageshwara Gullapalli Department of Internal Medicine Reno School of MedicineUniversity of NevadaRenoNV 89502United States Institute for Heart and Vascular Health Renown Regional Medical CenterRenoNV 89502United States

BACKGROUND Timely and accurate identification of subgroup at risk for major adverse cardiovascular events among patients presenting with acute chest pain remains a *** available risk stratification scores are ***,a new scoring system called the Symptoms,history of Vascular disease,Electrocardiography,Age,and Troponin(SVEAT)score has been shown to outperform the History,Electrocardiography,Age,Risk factors and Troponin(HEART)score,one of the most used risk scores in the United *** To assess the potential usefulness of the SVEAT score as a risk stratification tool by comparing its performance to HEART score in chest pain patients with low suspicion for acute coronary syndrome and admitted for overnight *** We retrospectively reviewed medical records of 330 consecutive patients admitted to our clinical decision unit for acute chest pain between January 1st to April 17th,*** avoid potential biases,investigators assigned to calculate the SVEAT,and HEART scores were blinded to the results of 30-d combined endpoint of death,acute myocardial infarction or confirmed coronary artery disease requiring revascularization or medical therapy[30-d major adverse cardiovascular event(MACE)].An area under receiving-operator characteristic curve(AUC)for each score was then calculated.C-statistic and logistic model were used to compare RESULTS A 30-d MACE was observed in 11 patients(3.33%of the subjects).The AUC of SVEAT score(0.8876,95%CI:0.82-0.96)was significantly higher than the AUC of HEART score(0.7962,95%CI:0.71-0.88),P=*** logistic model,SVEAT score with cut-off of 4 or less significantly predicts 30-d MACE(odd ratio 1.52,95%CI:1.19-1.95,P=0.001)but not the HEART score(odd ratio 1.29,95%CI:0.78-2.14,P=0.32).CONCLUSION The SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.

关键词： acute chest pain Risk stratification tool Symptoms,history of Vascular disease,Electrocardiography,Age,and Troponin score History,Electrocardiography,Age,Risk factors and Troponin score

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Usefulness of PQRST pain assessment method for non-traumatic chest pain

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South China Journal of Cardiology 2018年第3期19卷 172-175,181页

作者：郭艳枫邓秋迎杨珊李彦丽刘青艳 Emergency Department GuangDong Province Hospital Of Traditional Chinese Medicine

Background The symptom of chest pain is one of the most common presenting complaints seen in primary and secondary care and is the leading cause of emergency department visits. PQRST pain assessment method might be useful, but contemporary researches of its feasibility for chest pain patients are limited. Methods Between March 2017 and August 2017, 533 consecutive patients as control group and 657 cases as treatment group were retrospectively recruited in the Emergency Department of our center. We compared the time took for the first cardiogram, the time spent in the emergency department, triage accuracy and patient stratification rate between two groups. Results In treatment group, statistically less time was spent to take the first cardiogram（5.3±1.2 vs. 11.2±2.5, P 〈 0.001）. This group had higher triage accuracy（92.34% vs. 86.91%, P = 0.003）and patient stratification（95.51% vs. 91.48%, P = 0.006）. Conclusions PQRST pain assessment method is useful and feasible for increasing triage accuracy and patient stratification rate of non-Traumatic chest pain patients in emergency department.

关键词： PQRST pain assessment method acute chest pain triage

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Takotsubo cardiomyopathy or acute myocardial infarction？

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Chinese Medical Journal 2012年第22期125卷 3928-3928页

作者： Chen Yu-cheng Sichuan Univ W China Hosp Dept Cardiol Chengdu 610041 Sichuan Peoples R China

To the editor： In the recent issue, XU Rong-he et alI reported one elderly age case with acute chest pain which was finally diagnosed as Takotsubo cardiomyoapthy. Authors provided us with detailed medical profiles; h... 详细信息

关键词： Takotsubo cardiomyoapthy acute chest pain finally diagnosed

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