Myocardial contrast echocardiography versus Thrombolysis In Myocardial Infarction score in patients presenting to the emergency department with chest pain and a nondiagnostic electrocardiogram.

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  • Additional Information
    • Source:
      Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
    • Publication Information:
      Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
    • Subject Terms:
      Emergency Service, Hospital* ; Myocardium*; Chest Pain/*diagnosis ; Coronary Circulation/*physiology ; Fibrinolytic Agents/*therapeutic use ; Myocardial Infarction/*diagnosis; Adult ; Aged ; Aged, 80 and over ; Echocardiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/drug therapy ; Myocardial Infarction/physiopathology ; Prognosis ; Prospective Studies ; Risk Assessment ; Surveys and Questionnaires ; Troponin/analysis ; Ventricular Function, Left/physiology
    • Abstract:
      Objectives: We hypothesized that regional function (RF) and myocardial perfusion (MP) are superior to the Thrombolysis In Myocardial Infarction (TIMI) score for diagnosis and prognostication in patients presenting to the emergency department (ED) with chest pain (CP) and a nondiagnostic electrocardiogram.
      Background: Rapid diagnosis and prognostication is difficult in patients presenting to the ED with suspected cardiac CP.
      Methods: Contrast echocardiography was performed to assess RF and MP on 957 patients presenting to the ED with suspected cardiac CP and a nondiagnostic electrocardiogram. A modified TIMI (mTIMI) score was calculated from six immediately available variables. A full TIMI score also was derived after troponin levels were able to be accessed adequately. Follow-up was performed for early (within 24 h), intermediate (30 day), and late primary (death and myocardial infarction) or secondary (unstable angina and revascularization) events.
      Results: The mTIMI score was unable to discriminate between intermediate- compared to high-risk patients at any follow-up time point, whereas only 2 of 523 patients with normal RF had an early primary event. Regional function provided incremental prognostic value over mTIMI scores for predicting intermediate and late events. In patients with abnormal RF, MP further classified patients into intermediate- and high-risk groups. The full TIMI score could not improve upon these results at any follow-up time point.
      Conclusions: Contrast echocardiography can rapidly and accurately provide short-, intermediate-, and long-term prognostic information in patients presenting to the ED with suspected cardiac CP even before serum cardiac markers are known. Integrating contrast echocardiography into the ED evaluation of CP may improve the risk stratification of such patients.
    • Comments:
      Comment in: J Am Coll Cardiol. 2005 Sep 6;46(5):928-9. (PMID: 16139145)
    • Grant Information:
      K08-HL03909 United States HL NHLBI NIH HHS
    • Accession Number:
      0 (Fibrinolytic Agents)
      0 (Troponin)
    • Publication Date:
      Date Created: 20050906 Date Completed: 20051205 Latest Revision: 20161124
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.jacc.2005.03.076
    • Accession Number:
      16139144