NATIONAL TRENDS IN OUTCOMES OF NON-ST-ELEVATION ACUTE CORONARY SYNDROMES IN ADULTS WITH END-STAGE RENAL DISEASE, 2005-2014
Bing YueChayakrit KrittanawongAbel Casso DominguezXin WeiMariam KhandakerAshish CorreaShuyang FangEyal Herzog
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The identification of acute coronary syndrome continues to challenge even experienced clinicians. Emergency physicians have the responsibility to identify, treat and admit those patients with true acute coronary syndrome to the appropriate units. This article described a case of acute coronary syndrome that developed in the observation ward, with discussion on some recent reviews of standard electrocardiogram analysis. It is very important to point out that controversy over the measurement of ST elevation exists which may adversely affect patient management.
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The aim of this study was to better delineate the characteristics, treatments and outcomes of patients with acute coronary syndromes in Emilia Romagna, a region of Italy, with 4 million inhabitants.From January 10 to March 12, 2000, we performed a prospective survey (24/27 hospitals of the region) on 1074 consecutive patients with a discharge diagnosis of acute coronary syndrome.Based on the initial electrocardiogram, patients were classified as having an ST-elevation acute coronary syndrome in 41% of cases, a non-ST-elevation acute coronary syndrome in 54%, and an acute coronary syndrome with an undetermined electrocardiographic pattern in 5%. The discharge diagnosis was Q wave myocardial infarction in 43%, non-Q wave myocardial infarction in 26%, and unstable angina in 31% of patients. The use of antiplatelet, beta-blockers, ACE-inhibitors, and antithrombin agents for patients with ST-elevation acute coronary syndromes were 96, 62, 56, and 93%, respectively, with corresponding rates of 93, 63, 53, and 87% for non-ST-elevation acute coronary syndromes. During the initial admission, coronary angiography, percutaneous coronary intervention, and coronary bypass surgery were performed in 31, 15, and 1% of ST-elevation acute coronary syndrome patients, respectively, with corresponding rates of 43, 15, and 5% for non-ST-elevation acute coronary syndromes. Among patients with ST-elevation acute coronary syndromes, 61% received a reperfusion treatment; 58% coronary thrombolysis, and 3% primary percutaneous coronary intervention. The in-hospital mortality of patients with ST-elevation acute coronary syndromes was 10%, of patients with non-ST-elevation acute coronary syndromes 3%, and of patients with underdetermined electrocardiographic acute coronary syndromes 8%. At 6 months, the mortality rate increased to 16, 8, and 18%, respectively.Our data show the use of evidence-based pharmacological treatments in this population. This is associated with clinical outcomes which favorably compare with those observed in clinical trials. However, there is still room for improvement in the implementation of the invasive treatment.
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The aim was to study early outcomes in patients with suspected acute coronary syndrome without ST elevation who were transported by emergency to the vascular center. Material and Methods . We studied medical records from 396 patients with suspected acute coronary syndrome without ST elevation. A telephone survey of patients or their relatives was conducted within two months after the emergency call. Results . In-hospital diagnosis of acute coronary syndrome was confirmed only in 30.6% of patients with suspected acute coronary syndrome without ST elevation admitted to the vascular center. Cardiologists in the vascular center were ruling out diagnosis of acute coronary syndrome without ST elevation based on data of clinical examination and electrocardiography. During the following two months, 6.4% of the patients with ruled out diagnosis of acute coronary syndrome called emergency again; 2% of the patients were admitted with acute coronary syndrome to the vascular center; and 2.4% of the patients died at home. Conclusion . In real clinical practice, the assessment of myocardial necrosis biomarkers has been used not enough in cases of suspected acute coronary syndrome without ST elevation.
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Objective: Researching the relationship between C-reactive protein and non- ST elevation acute coronary syndrome and its clinical meaning. Methods: Measuring C-reactive protein value of 62 patients with non- ST elevation acute coronary syndrome and 80 stable angina in the hospital from Jan 2000 to Jan 2005, observing the difference of two different type coronary heart disease. Results: There was obvious difference between non-ST elevation acute coronary syndrome and stable angina. Conclusion: C-reactive protein and non- ST elevation acute coronary syndrome have obvious relativity, can be the basis that discriminates non- ST elevation acute coronary syndrome for stable angina on clinic.
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Objective: The magnitude of ST elevation is a key piece of information in the decision to thrombolyse in acute myocardial infarction. The ability of clinicians to reliably identify ST elevation has not been previously assessed. This study sought to determine the variability in assessment of ST elevation in a group of doctors who commonly prescribe thrombolysis. Methods: The study was conducted in three large teaching hospitals in Manchester, England. A convenience sample of 63 SHOs and SpRs from emergency and general medicine were recruited. Each was shown three sample ECG complexes. They were asked to identify and quantify the degree of ST elevation. They then indicated the points on the ECG from which they measured ST elevation. Results: ST elevation was not identified in 12% of cases. Doctors used a wide variety of points on the ST segment to assess elevation, this resulted in a wide variation in the observed magnitude of ST elevation. Conclusion: No guidance exists on where exactly ST elevation should be measured. This study shows a wide variation in practice. Protocol led thrombolysis decision pathways may be compromised by these findings.
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Background: Early repolarization pattern (ERP) is a well known normal variant. There is another kind of ST elevation in the mid precordial leads as a normal variant (Fig 1), which is distinctively ...
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Objective To investigate the relationship between the plasma C -reactive protein and non -ST elevation acute coronary syndrome and its clinical significance.Methods The plasma Creactive protein levels of 112 patients with non -ST elevation acute coronary syndrome and 90 stable angina in the hospital from Feb.2004 to Feb.2010 were detected,the differences of two different type coronary heart disease were observed.Results There was obvious difference between non -ST elevation acute coronary syndrome and stable angina.Conclusions The plasma C - reactive protein and non - ST elevation acute coronary syndrome have obvious correlation,and can be important for discriminating non - ST elevation acute coronary syndrome from stable angina on clinic.
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Plasma C -reactive protein; Acute coronary syndrome; Stable angina
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