Predictors of revascularization among emergency department patients who are evaluated for acute coronary syndrome.
BACKGROUND
To determine, among patients who present to the emergency department with symptoms suggestive of acute coronary syndrome (ACS), predictors of short-term revascularization.


METHODS
A prospective descriptive trial was performed. Potential predictors for revascularization were measured by means of a questionnaire of providers, serum for cardiac biomarkers, and an initial ECG. The primary outcome of revascularization (coronary bypass graft or percutaneous intervention) was determined through a medical record review. Potential predictors of revascularization were entered into a family of logistic regressions.


RESULTS
341 eligible subjects were enrolled, of whom 14% underwent revascularization. The predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization.


CONCLUSIONS
In a single site study, among emergency department patients with symptoms suggestive of ACS, ST elevation on initial ECG and an elevation in troponin I, CK-MB, and myoglobin upon presentation all predicted short -term revascularization. Among the three biomarkers, elevation in troponin I was the strongest predictor. ABBREVIATED ABSTRACT: We conducted a prospective descriptive trial to identify predictors of short-term revascularization among 341 emergency department patients who presented with symptoms suggestive of ACS. Fourteen percent of the study population received revascularization. Predictors of revascularization included ST elevation on initial ECG (odds ratio 12.0.), and an elevation in troponin I (odds ratio 8.9), CKMB (odds ratio 6.8), or myoglobin (odds ratio 4.7) on admission. When all three biomarkers competed in the same model, troponin I appeared to be the strongest predictor of short-term revascularization.
Massachusetts General Hospital, Clinics 115, 55 Fruit Street, Boston, MA 02114, USA. Nagurney.john@mgh.harvard.edu
John T
JT
Nagurney
David Frank
DF
Brown
Claudia
C
Chae
YuChiao
Y
Chang
Won
W
Chung
Hilarie
H
Cranmer
Li
L
Dan
Jonathan
J
Fisher
Shamai
S
Grossman
Usha
U
Tedrow
Kent
K
Lewandrowski
Ik-Kyung
IK
Jang
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome