ST Monitoring and the Early Diagnosis of Myocardial Ischemia/Infarction in the Low Risk Chest Pain Patient

2.50
Hdl Handle:
http://hdl.handle.net/10755/162602
Type:
Presentation
Title:
ST Monitoring and the Early Diagnosis of Myocardial Ischemia/Infarction in the Low Risk Chest Pain Patient
Abstract:
ST Monitoring and the Early Diagnosis of Myocardial Ischemia/Infarction in the Low Risk Chest Pain Patient
Conference Sponsor:Emergency Nurses Association
Conference Year:1995
Author:Joseph, Anthony J.
P.I. Institution Name:Riverside Methodist Hospitals
Contact Address:3535 Olentangy River Road, Columbus, OH, 43214, USA
Objectives: To show that use of continuous 12 lead ST monitoring (STM) in low risk chest pain patients decreases time to diagnosis of ischemia/infarction and has predictive value for stress testing.

Methods: Randomized, prospective trial in which 281 consecutive patients with a chief complaint of chest pain and meeting eligibility requirements were assigned to either the chest pain protocol (CPK/CK-MB and EKG at 0, 6, and 12 hours after arrival) or that, plus continuous ST monitoring.

Subjects: 30 years or older, no heart disease, had at least one major or two minor risk factors (AHA). Subjects had stress thallium testing after 12 hours if not contraindicated and were followed up in 30 days.

Setting: Community hospital ED with 65,000 visits/year.

Results: 54.4% were randomized to the STM group; 45.6% had routine protocol. Both groups were alike in age, gender, nature of chest pain, and risk factors. Of the 153 subjects in the ST monitored group, 9 alarmed, 144 did not. The positive predictive valve for ischemia was 11.1% (1/9) and for infarct, 22.2% (2/9). In the two ischemic patients (diagnosed with unstable angina), the STM alarm cut 65 and 0 minutes off the diagnostic time (i.e., recurrent pain or scheduled testing). In the two patients with myocardial infarction, the reduction was 63 and 5 minutes. One of the 144 subjects who did not alarm was diagnosed with ischemia by stress thallium for a negative predictive value of 99.3%.

Conclusions: Continuous 12 lead ST monitoring in a subset of low risk chest pain patients shows promise for decreasing time to diagnosis of cardiac ischemia or infarction. A 12 hour period of ST monitoring has a strong negative predictive value for stress testing. [Research Paper Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleST Monitoring and the Early Diagnosis of Myocardial Ischemia/Infarction in the Low Risk Chest Pain Patienten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162602-
dc.description.abstract<table><tr><td colspan="2" class="item-title">ST Monitoring and the Early Diagnosis of Myocardial Ischemia/Infarction in the Low Risk Chest Pain Patient</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1995</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Joseph, Anthony J.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Riverside Methodist Hospitals</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3535 Olentangy River Road, Columbus, OH, 43214, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">res@ena.org</td></tr><tr><td colspan="2" class="item-abstract">Objectives: To show that use of continuous 12 lead ST monitoring (STM) in low risk chest pain patients decreases time to diagnosis of ischemia/infarction and has predictive value for stress testing.<br/><br/>Methods: Randomized, prospective trial in which 281 consecutive patients with a chief complaint of chest pain and meeting eligibility requirements were assigned to either the chest pain protocol (CPK/CK-MB and EKG at 0, 6, and 12 hours after arrival) or that, plus continuous ST monitoring.<br/><br/>Subjects: 30 years or older, no heart disease, had at least one major or two minor risk factors (AHA). Subjects had stress thallium testing after 12 hours if not contraindicated and were followed up in 30 days.<br/><br/>Setting: Community hospital ED with 65,000 visits/year.<br/><br/>Results: 54.4% were randomized to the STM group; 45.6% had routine protocol. Both groups were alike in age, gender, nature of chest pain, and risk factors. Of the 153 subjects in the ST monitored group, 9 alarmed, 144 did not. The positive predictive valve for ischemia was 11.1% (1/9) and for infarct, 22.2% (2/9). In the two ischemic patients (diagnosed with unstable angina), the STM alarm cut 65 and 0 minutes off the diagnostic time (i.e., recurrent pain or scheduled testing). In the two patients with myocardial infarction, the reduction was 63 and 5 minutes. One of the 144 subjects who did not alarm was diagnosed with ischemia by stress thallium for a negative predictive value of 99.3%.<br/><br/>Conclusions: Continuous 12 lead ST monitoring in a subset of low risk chest pain patients shows promise for decreasing time to diagnosis of cardiac ischemia or infarction. A 12 hour period of ST monitoring has a strong negative predictive value for stress testing. [Research Paper Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:30:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:57Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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