PMID- 32511135
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20230912
IS  - 1535-2811 (Electronic)
IS  - 1535-2811 (Linking)
VI  - 20
IP  - 1
DP  - 2021 Mar 1
TI  - Prevalence and Predictors of Obstructive Coronary Artery Disease in Nonlow-risk 
      Acute Chest Pain Patients Who Rule Out for Myocardial Infarction in the 
      High-sensitivity Troponin Era.
PG  - 10-15
LID - 10.1097/HPC.0000000000000229 [doi]
AB  - OBJECTIVES: The best management approach for chest pain patients who rule out for 
      myocardial infarction (MI) in the high-sensitivity troponin (hsTn) era remains 
      elusive. Patients, especially those with nonlow clinical risk scores, are often 
      referred for inpatient ischemic testing to uncover obstructive coronary artery 
      disease (CAD). Whether the prevalence of obstructive CAD in this cohort is high 
      enough to justify routine testing is not known. METHODS: We conducted a 
      retrospective cohort analysis of 1517 emergency department chest pain patients 
      who ruled out for MI by virtue of a stable high-sensitivity troponin T (hsTnT) 
      levels (defined as <5 ng/L intermeasurements increase) and were admitted for 
      inpatient testing. RESULTS: Abnormal ischemia evaluation (including 5.9% with 
      evidence of fixed wall motion or perfusion defects) was 11.9%. Of those 
      undergoing invasive angiography (n = 292), significant coronary stenoses (>/=70% or 
      unstable lesions) and multivessel CAD occurred in 16.8% and 5.5%, respectively. 
      In a multivariate logistic regression model, known CAD, prior MI, chest pain 
      character, mildly elevated hsTnT, and left ventricular ejection fraction <40% 
      were predictive of an abnormal ischemia evaluation result, whereas 
      electrocardiography findings and the modified History, EKG, Age, Risk factors, 
      and troponin (HEART) score were not. Of note, 30-day adverse cardiac events were 
      strikingly low at 0.4% with no deaths despite an overwhelming majority (>90%) of 
      patients scoring intermediate or high on the modified HEART score. CONCLUSIONS: A 
      considerable percentage of acute chest pain patients who rule out for MI by hsTn 
      had evidence of obstructive CAD, and the modified HEART score was not predictive 
      of an abnormal ischemia evaluation.
CI  - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Mahmoud, Osama
AU  - Mahmoud O
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Beer, Dominik
AU  - Beer D
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Mahmaljy, Hadi
AU  - Mahmaljy H
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Youniss, Mohamed
AU  - Youniss M
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Campoverde, Edwin Hernandez
AU  - Campoverde EH
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Elias, Hadi
AU  - Elias H
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
FAU - Stanton, Matthew
AU  - Stanton M
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Patel, Maulin
AU  - Patel M
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Hashmi, Insia
AU  - Hashmi I
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Young, Katelyn
AU  - Young K
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Kuppuraju, Rajesh
AU  - Kuppuraju R
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Jacobs, Steven
AU  - Jacobs S
AD  - Department of Internal Medicine, Geisinger Medical Center, Danville, PA.
FAU - Alsaid, Amro
AU  - Alsaid A
AD  - From the Heart Institute, Geisinger Medical Center, Danville, PA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Crit Pathw Cardiol
JT  - Critical pathways in cardiology
JID - 101165286
RN  - 0 (Troponin)
SB  - IM
MH  - Chest Pain/diagnosis/epidemiology/etiology
MH  - *Coronary Artery Disease/diagnosis/epidemiology
MH  - Electrocardiography
MH  - Emergency Service, Hospital
MH  - Humans
MH  - *Myocardial Infarction/diagnosis/epidemiology
MH  - Predictive Value of Tests
MH  - Prevalence
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stroke Volume
MH  - Troponin
MH  - Ventricular Function, Left
EDAT- 2020/06/09 06:00
MHDA- 2021/10/26 06:00
CRDT- 2020/06/09 06:00
PHST- 2020/06/09 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2020/06/09 06:00 [entrez]
AID - 00132577-202103000-00003 [pii]
AID - 10.1097/HPC.0000000000000229 [doi]
PST - ppublish
SO  - Crit Pathw Cardiol. 2021 Mar 1;20(1):10-15. doi: 10.1097/HPC.0000000000000229.