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43966

Emergency Room Risk Stratification of Patients with Chest Pain without ST Segment Elevation

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Last updated: 22 Jan 2023

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Abstract

Background: Emergency room triage of patients with chest pain is an ongoing challenge.Over the years a number of modalities have been evolved for rapid diagnosis and better risk stratification of patients. Aim: to investigate the prognostic factors in patients who came to the Emergency Department with chest pain suspected of acute coronary syndrome without ST segment elevation. Patients and Methods: one-hundred and three consecutive patients (from Suez Canal university Hospital and Al Monira General Hospital) were evaluated by recording clinical history, electrocardiogram and troponin determination. Early (< 24 h) exercise testing was done for the low-risk subgroup of patients (n= 28). All patients were followed up for 3 months for major events (acute myocardial infarction or death). Results: Major events occurred in 14 patients (9.6%). Multivariate analysis identified the following predictors: age ≥65 years (OR = 1.7; p = 0.05), diabetes mellitus (OR = 2.9; p = 0.001), previous ischemic heart disease (OR = 2.5; p = 0.004), ST depression (OR = 2.1; p = 0.048) and troponin elevation (OR = 2.6; p = 0.003). These five predictors were used to construct a risk score based on their odds ratios, which allowed event risk stratification 0-3 points low risk 48% of the studied patients, 4-7 points intermediate risk 31% of the studied patients, 8 points or more high risk 21%of studied patients. Conclusions: In patients with chest pain, the combination of clinical, electrocardiographic and biochemical data available on admission to the emergency service allows rapid prognostic stratification. Early exercise testing is advisable for the final stratification of low risk patients.  

DOI

10.21608/scumj.2016.43966

Keywords

Triage, Acute Coronary Syndrome, Er

Authors

First Name

Emad Eldin

Last Name

Ismail

MiddleName

-

Affiliation

Department of Biochemistry, Faculty of Medicine, Suez Canal University, Egypt

Email

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City

-

Orcid

-

First Name

Gamela

Last Name

Nasr

MiddleName

-

Affiliation

Departments of Cardiology, Faculty of Medicine, Suez Canal University, Egypt

Email

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City

-

Orcid

-

First Name

Adel

Last Name

Elbaih

MiddleName

H

Affiliation

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt

Email

elbaihzico@yahoo.com

City

-

Orcid

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First Name

Monira

Last Name

Ismail

MiddleName

T

Affiliation

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt

Email

-

City

-

Orcid

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First Name

Yahia

Last Name

Elemam

MiddleName

-

Affiliation

Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Egypt

Email

-

City

-

Orcid

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Volume

19

Article Issue

1

Related Issue

6813

Issue Date

2016-03-01

Receive Date

2019-08-05

Publish Date

2016-03-01

Page Start

68

Page End

75

Print ISSN

1110-6999

Online ISSN

2090-2581

Article File

SCUMJ_Volume 19_Issue 1_Pages 68-75.pdf

PDF . 882.6kB

Link

https://scumj.journals.ekb.eg/article_43966.html

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https://scumj.journals.ekb.eg/service?article_code=43966

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Original Article

Type Code

938

Publication Type

Journal

Publication Title

Suez Canal University Medical Journal

Publication Link

https://scumj.journals.ekb.eg/

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Article

Created At

22 Jan 2023