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Necessity of hospitalization and stress testing in low risk chest pain patients.

Authors :
Beri N
Marston NA
Daniels LB
Nowak RM
Schreiber D
Mueller C
Jaffe A
Diercks DB
Wettersten N
DeFilippi C
Peacock WF
Limkakeng AT
Anand I
McCord J
Hollander JE
Wu AHB
Apple FS
Nagurney JT
Berardi C
Cannon CM
Clopton P
Neath SX
Christenson RH
Hogan C
Vilke G
Maisel A
Source :
The American journal of emergency medicine [Am J Emerg Med] 2017 Feb; Vol. 35 (2), pp. 274-280. Date of Electronic Publication: 2016 Oct 29.
Publication Year :
2017

Abstract

Background: Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI).<br />Objectives: The goal of this study was to demonstrate that patients with a normal electrocardiogram and cTnI<0.040μg/l and copeptin<14pmol/l at presentation and after 2 h may be candidates for early discharge with outpatient follow-up potentially including stress testing.<br />Methods: This study uses data from the CHOPIN trial which enrolled 2071 patients with acute chest pain. Of those, 475 patients with normal electrocardiogram and normal cTnI(<0.040μg/l) and copeptin<14pmol/l at presentation and after 2 h were considered "low risk" and selected for further analysis.<br />Results: None of the 475 "low risk" patients were diagnosed with MI during the 180day follow-up period (including presentation). The negative predictive value of this strategy was 100% (95% confidence interval(CI):99.2%-100.0%). Furthermore no one died during follow up. 287 (60.4%) patients in the low risk group were hospitalized. In the "low risk" group, the only difference in outcomes (MI, death, revascularization, cardiac rehospitalization) was those hospitalized underwent revascularization more often (6.3%[95%CI:3.8%-9.7%] versus 0.5%[95%CI:0.0%-2.9%], p=.002). The hospitalized patients were tested significantly more via stress testing or angiogram (68.6%[95%CI:62.9%-74.0%] vs 22.9%[95%CI:17.1%-29.6%], p<.001). Those tested had less cardiac rehospitalizations during follow-up (1.7% vs 5.1%, p=.040).<br />Conclusions: In conclusion, patients with a normal electrocardiogram, troponin and copeptin at presentation and after 2 h are at low risk for MI and death over 180days. These low risk patients may be candidates for early outpatient testing and cardiology follow-up thereby reducing hospitalization.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1532-8171
Volume :
35
Issue :
2
Database :
MEDLINE
Journal :
The American journal of emergency medicine
Publication Type :
Academic Journal
Accession number :
27847253
Full Text :
https://doi.org/10.1016/j.ajem.2016.10.072