A Predictive Instrument Using Contrast Echocardiography in Patients Presenting to the Emergency Department with Chest Pain and without ST-Segment Elevation

Kevin Wei, Dawn Peters, Todd Belcik, Saul Kalvaitis, Lisa Womak, Diana Rinkevich, Khim Leng Tong, Kenneth Horton, Sanjiv Kaul

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Risk stratification of patients presenting to the emergency department (ED) with suspected cardiac chest pain (CP) and an undifferentiated electrocardiogram (ECG) is difficult. We hypothesized that in these patients a risk score incorporating clinical, ECG, and myocardial contrast echocardiography (MCE) variables would accurately predict adverse events occurring within the next 48 hours. Methods: Patients with CP lasting for 30 minutes or more who did not have ST-segment elevation on the ECG, were enrolled. Regional function (RF) and myocardial perfusion (MP) were assessed by MCE. A risk model was developed in the initial 1166 patients (cohort 1) and validated in subsequent 720 patients (cohort 2). Any abnormality or ST changes on ECG (odds ratio [OR] 2.5; 95% confidence interval [CI], 1.4-4.5, P = .002, and OR 2.9, 95% CI, 1.7-4.8, P <.001, respectively), abnormal RF with normal MP (OR 3.5, 95% CI, 1.8-6.5, P <.001), and abnormal RF with abnormal MP (OR 9.6, 95% CI, 5.8-16.0, P <.001) were found to be significant multivariate predictors of nonfatal myocardial infarction or cardiac death. Results: The estimate of the probability of concordance for the risk model was 0.82 for cohort 1 and 0.83 for cohort 2. The risk score in both cohorts stratified patients into 5 distinct risk groups with event rates ranging from 0.3% to 58%. Conclusion: A simple predictive instrument has been developed from clinical, ECG, and MCE findings obtained at the bedside that can accurately predict events occurring within 48 hours in patients presenting to the ED with suspected cardiac CP and an ECG that is not diagnostic for acute ischemic injury. Its application could enhance care of patients with CP in the ED. For instance, patients with a risk score of 0 could be discharged from the ED without further workup. However, this needs to be validated in a multicenter study.

Original languageEnglish (US)
Pages (from-to)636-642
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume23
Issue number6
DOIs
StatePublished - Jun 2010

Fingerprint

Chest Pain
Echocardiography
Hospital Emergency Service
Electrocardiography
Odds Ratio
Confidence Intervals
Perfusion
Multicenter Studies
Patient Care
Myocardial Infarction
Wounds and Injuries

Keywords

  • Chest pain
  • Emergency department
  • Myocardial contrast echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

A Predictive Instrument Using Contrast Echocardiography in Patients Presenting to the Emergency Department with Chest Pain and without ST-Segment Elevation. / Wei, Kevin; Peters, Dawn; Belcik, Todd; Kalvaitis, Saul; Womak, Lisa; Rinkevich, Diana; Tong, Khim Leng; Horton, Kenneth; Kaul, Sanjiv.

In: Journal of the American Society of Echocardiography, Vol. 23, No. 6, 06.2010, p. 636-642.

Research output: Contribution to journalArticle

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title = "A Predictive Instrument Using Contrast Echocardiography in Patients Presenting to the Emergency Department with Chest Pain and without ST-Segment Elevation",
abstract = "Objective: Risk stratification of patients presenting to the emergency department (ED) with suspected cardiac chest pain (CP) and an undifferentiated electrocardiogram (ECG) is difficult. We hypothesized that in these patients a risk score incorporating clinical, ECG, and myocardial contrast echocardiography (MCE) variables would accurately predict adverse events occurring within the next 48 hours. Methods: Patients with CP lasting for 30 minutes or more who did not have ST-segment elevation on the ECG, were enrolled. Regional function (RF) and myocardial perfusion (MP) were assessed by MCE. A risk model was developed in the initial 1166 patients (cohort 1) and validated in subsequent 720 patients (cohort 2). Any abnormality or ST changes on ECG (odds ratio [OR] 2.5; 95{\%} confidence interval [CI], 1.4-4.5, P = .002, and OR 2.9, 95{\%} CI, 1.7-4.8, P <.001, respectively), abnormal RF with normal MP (OR 3.5, 95{\%} CI, 1.8-6.5, P <.001), and abnormal RF with abnormal MP (OR 9.6, 95{\%} CI, 5.8-16.0, P <.001) were found to be significant multivariate predictors of nonfatal myocardial infarction or cardiac death. Results: The estimate of the probability of concordance for the risk model was 0.82 for cohort 1 and 0.83 for cohort 2. The risk score in both cohorts stratified patients into 5 distinct risk groups with event rates ranging from 0.3{\%} to 58{\%}. Conclusion: A simple predictive instrument has been developed from clinical, ECG, and MCE findings obtained at the bedside that can accurately predict events occurring within 48 hours in patients presenting to the ED with suspected cardiac CP and an ECG that is not diagnostic for acute ischemic injury. Its application could enhance care of patients with CP in the ED. For instance, patients with a risk score of 0 could be discharged from the ED without further workup. However, this needs to be validated in a multicenter study.",
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T1 - A Predictive Instrument Using Contrast Echocardiography in Patients Presenting to the Emergency Department with Chest Pain and without ST-Segment Elevation

AU - Wei, Kevin

AU - Peters, Dawn

AU - Belcik, Todd

AU - Kalvaitis, Saul

AU - Womak, Lisa

AU - Rinkevich, Diana

AU - Tong, Khim Leng

AU - Horton, Kenneth

AU - Kaul, Sanjiv

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N2 - Objective: Risk stratification of patients presenting to the emergency department (ED) with suspected cardiac chest pain (CP) and an undifferentiated electrocardiogram (ECG) is difficult. We hypothesized that in these patients a risk score incorporating clinical, ECG, and myocardial contrast echocardiography (MCE) variables would accurately predict adverse events occurring within the next 48 hours. Methods: Patients with CP lasting for 30 minutes or more who did not have ST-segment elevation on the ECG, were enrolled. Regional function (RF) and myocardial perfusion (MP) were assessed by MCE. A risk model was developed in the initial 1166 patients (cohort 1) and validated in subsequent 720 patients (cohort 2). Any abnormality or ST changes on ECG (odds ratio [OR] 2.5; 95% confidence interval [CI], 1.4-4.5, P = .002, and OR 2.9, 95% CI, 1.7-4.8, P <.001, respectively), abnormal RF with normal MP (OR 3.5, 95% CI, 1.8-6.5, P <.001), and abnormal RF with abnormal MP (OR 9.6, 95% CI, 5.8-16.0, P <.001) were found to be significant multivariate predictors of nonfatal myocardial infarction or cardiac death. Results: The estimate of the probability of concordance for the risk model was 0.82 for cohort 1 and 0.83 for cohort 2. The risk score in both cohorts stratified patients into 5 distinct risk groups with event rates ranging from 0.3% to 58%. Conclusion: A simple predictive instrument has been developed from clinical, ECG, and MCE findings obtained at the bedside that can accurately predict events occurring within 48 hours in patients presenting to the ED with suspected cardiac CP and an ECG that is not diagnostic for acute ischemic injury. Its application could enhance care of patients with CP in the ED. For instance, patients with a risk score of 0 could be discharged from the ED without further workup. However, this needs to be validated in a multicenter study.

AB - Objective: Risk stratification of patients presenting to the emergency department (ED) with suspected cardiac chest pain (CP) and an undifferentiated electrocardiogram (ECG) is difficult. We hypothesized that in these patients a risk score incorporating clinical, ECG, and myocardial contrast echocardiography (MCE) variables would accurately predict adverse events occurring within the next 48 hours. Methods: Patients with CP lasting for 30 minutes or more who did not have ST-segment elevation on the ECG, were enrolled. Regional function (RF) and myocardial perfusion (MP) were assessed by MCE. A risk model was developed in the initial 1166 patients (cohort 1) and validated in subsequent 720 patients (cohort 2). Any abnormality or ST changes on ECG (odds ratio [OR] 2.5; 95% confidence interval [CI], 1.4-4.5, P = .002, and OR 2.9, 95% CI, 1.7-4.8, P <.001, respectively), abnormal RF with normal MP (OR 3.5, 95% CI, 1.8-6.5, P <.001), and abnormal RF with abnormal MP (OR 9.6, 95% CI, 5.8-16.0, P <.001) were found to be significant multivariate predictors of nonfatal myocardial infarction or cardiac death. Results: The estimate of the probability of concordance for the risk model was 0.82 for cohort 1 and 0.83 for cohort 2. The risk score in both cohorts stratified patients into 5 distinct risk groups with event rates ranging from 0.3% to 58%. Conclusion: A simple predictive instrument has been developed from clinical, ECG, and MCE findings obtained at the bedside that can accurately predict events occurring within 48 hours in patients presenting to the ED with suspected cardiac CP and an ECG that is not diagnostic for acute ischemic injury. Its application could enhance care of patients with CP in the ED. For instance, patients with a risk score of 0 could be discharged from the ED without further workup. However, this needs to be validated in a multicenter study.

KW - Chest pain

KW - Emergency department

KW - Myocardial contrast echocardiography

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