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Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department

For patients with chest pain who are deemed clinically to be low risk and discharged home from the emergency department (ED), it is unclear whether further laboratory tests can improve risk stratification. Here, we investigated the utility of a clinical chemistry score (CCS), which comprises plasma...

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Autores principales: Kavsak, Peter A., Cerasuolo, Joshua O., Mondoux, Shawn E., Sherbino, Jonathan, Ma, Jinhui, Hoard, Brock K., Perez, Richard, Seow, Hsien, Ko, Dennis T., Worster, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565964/
https://www.ncbi.nlm.nih.gov/pubmed/32932598
http://dx.doi.org/10.3390/jcm9092948
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author Kavsak, Peter A.
Cerasuolo, Joshua O.
Mondoux, Shawn E.
Sherbino, Jonathan
Ma, Jinhui
Hoard, Brock K.
Perez, Richard
Seow, Hsien
Ko, Dennis T.
Worster, Andrew
author_facet Kavsak, Peter A.
Cerasuolo, Joshua O.
Mondoux, Shawn E.
Sherbino, Jonathan
Ma, Jinhui
Hoard, Brock K.
Perez, Richard
Seow, Hsien
Ko, Dennis T.
Worster, Andrew
author_sort Kavsak, Peter A.
collection PubMed
description For patients with chest pain who are deemed clinically to be low risk and discharged home from the emergency department (ED), it is unclear whether further laboratory tests can improve risk stratification. Here, we investigated the utility of a clinical chemistry score (CCS), which comprises plasma glucose, the estimated glomerular filtration rate, and high-sensitivity cardiac troponin (I or T) to generate a common score for risk stratification. In a cohort of 14,676 chest pain patients in the province of Ontario, Canada and who were discharged home from the ED (November 2012–February 2013 and April 2013–September 2015) we evaluated the CCS as a risk stratification tool for all-cause mortality, plus hospitalization for myocardial infarction or unstable angina (primary outcome) at 30, 90, and 365 days post-discharge using Cox proportional hazard models. At 30 days the primary outcome occurred in 0.3% of patients with a CCS < 2 (n = 6404), 0.9% of patients with a CCS = 2 (n = 4336), and 2.3% of patients with a CCS > 2 (n = 3936) (p < 0.001). At 90 days, patients with CCS < 2 (median age = 52y (IQR = 46–60), 59.4% female) had an adjusted HR = 0.51 (95% confidence interval (CI) = 0.32–0.82) for the composite outcome and patients with a CCS > 2 (median age = 74y (IQR = 64–82), 48.0% female) had an adjusted HR = 2.80 (95%CI = 1.98–3.97). At 365 days, 1.3%, 3.4%, and 11.1% of patients with a CCS < 2, 2, or >2 respectively, had the composite outcome (p < 0.001). In conclusion, the CCS can risk stratify chest pain patients discharged home from the ED and identifies both low- and high-risk patients who may warrant different medical care.
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spelling pubmed-75659642020-10-26 Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department Kavsak, Peter A. Cerasuolo, Joshua O. Mondoux, Shawn E. Sherbino, Jonathan Ma, Jinhui Hoard, Brock K. Perez, Richard Seow, Hsien Ko, Dennis T. Worster, Andrew J Clin Med Article For patients with chest pain who are deemed clinically to be low risk and discharged home from the emergency department (ED), it is unclear whether further laboratory tests can improve risk stratification. Here, we investigated the utility of a clinical chemistry score (CCS), which comprises plasma glucose, the estimated glomerular filtration rate, and high-sensitivity cardiac troponin (I or T) to generate a common score for risk stratification. In a cohort of 14,676 chest pain patients in the province of Ontario, Canada and who were discharged home from the ED (November 2012–February 2013 and April 2013–September 2015) we evaluated the CCS as a risk stratification tool for all-cause mortality, plus hospitalization for myocardial infarction or unstable angina (primary outcome) at 30, 90, and 365 days post-discharge using Cox proportional hazard models. At 30 days the primary outcome occurred in 0.3% of patients with a CCS < 2 (n = 6404), 0.9% of patients with a CCS = 2 (n = 4336), and 2.3% of patients with a CCS > 2 (n = 3936) (p < 0.001). At 90 days, patients with CCS < 2 (median age = 52y (IQR = 46–60), 59.4% female) had an adjusted HR = 0.51 (95% confidence interval (CI) = 0.32–0.82) for the composite outcome and patients with a CCS > 2 (median age = 74y (IQR = 64–82), 48.0% female) had an adjusted HR = 2.80 (95%CI = 1.98–3.97). At 365 days, 1.3%, 3.4%, and 11.1% of patients with a CCS < 2, 2, or >2 respectively, had the composite outcome (p < 0.001). In conclusion, the CCS can risk stratify chest pain patients discharged home from the ED and identifies both low- and high-risk patients who may warrant different medical care. MDPI 2020-09-12 /pmc/articles/PMC7565964/ /pubmed/32932598 http://dx.doi.org/10.3390/jcm9092948 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kavsak, Peter A.
Cerasuolo, Joshua O.
Mondoux, Shawn E.
Sherbino, Jonathan
Ma, Jinhui
Hoard, Brock K.
Perez, Richard
Seow, Hsien
Ko, Dennis T.
Worster, Andrew
Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title_full Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title_fullStr Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title_full_unstemmed Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title_short Risk Stratification for Patients with Chest Pain Discharged Home from the Emergency Department
title_sort risk stratification for patients with chest pain discharged home from the emergency department
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565964/
https://www.ncbi.nlm.nih.gov/pubmed/32932598
http://dx.doi.org/10.3390/jcm9092948
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