Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction
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Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction. / Koechlin, Luca; Boeddinghaus, Jasper; Nestelberger, Thomas; Miró, Òscar; Fuenzalida, Carolina; Martinez-Nadal, Gemma; López, Beatriz; Wussler, Desiree; Walter, Joan; Zimmermann, Tobias; Troester, Valentina; Lopez-Ayala, Pedro; Baumgartner, Benjamin; Ratmann, Paul David; Diebold, Matthias; Prepoudis, Alexandra; Huber, Jeffrey; Christ, Michael; Wildi, Karin; Rubini Giménez, Maria; Strebel, Ivo; Gualandro, Danielle M; Martin-Sanchez, F Javier; Kawecki, Damian; Keller, Dagmar I; Reuthebuch, Oliver; Eckstein, Friedrich S; Reichlin, Tobias; Twerenbold, Raphael; Mueller, Christian; APACE Investigators.
in: EUR HEART J-ACUTE CA, Jahrgang 10, Nr. 7, 01.10.2021, S. 746-755.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Clinical presentation of patients with prior coronary artery bypass grafting and suspected acute myocardial infarction
AU - Koechlin, Luca
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Miró, Òscar
AU - Fuenzalida, Carolina
AU - Martinez-Nadal, Gemma
AU - López, Beatriz
AU - Wussler, Desiree
AU - Walter, Joan
AU - Zimmermann, Tobias
AU - Troester, Valentina
AU - Lopez-Ayala, Pedro
AU - Baumgartner, Benjamin
AU - Ratmann, Paul David
AU - Diebold, Matthias
AU - Prepoudis, Alexandra
AU - Huber, Jeffrey
AU - Christ, Michael
AU - Wildi, Karin
AU - Rubini Giménez, Maria
AU - Strebel, Ivo
AU - Gualandro, Danielle M
AU - Martin-Sanchez, F Javier
AU - Kawecki, Damian
AU - Keller, Dagmar I
AU - Reuthebuch, Oliver
AU - Eckstein, Friedrich S
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Mueller, Christian
AU - APACE Investigators
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - AIMS: Diagnosis of acute myocardial infarction (AMI) can be challenging in patients with prior coronary artery bypass grafting (CABG).METHODS AND RESULTS: Final diagnoses were adjudicated by two independent cardiologists using the universal definition of AMI among patients presenting to the emergency department (ED) with suspected AMI. Diagnostic accuracy of 34 chest pain characteristics (CPCs) and four electrocardiogram (ECG) signatures stratified according to the presence or absence of prior CABG were prospectively quantified. Among 4015 patients (no prior CABG: n = 3686; prior CABG: n = 329), prevalence of AMI and unstable angina were higher in patients with prior CABG (35% vs. 18%; 26% vs. 8%; both P < 0.001). Three CPCs (9%) and two electrocardiographic findings (50%) showed a different diagnostic performance (interaction P < 0.05) with loss of diagnostic value in patients with prior CABG. The diagnostic accuracy as quantified by the area under the curve (AUC) of the integrated clinical judgement was moderate to good in patients with prior CABG, and significantly lower compared to patients without prior CABG [AUC 0.80 (95% confidence interval (CI) 0.75-0.84) vs. AUC 0.87 (95% CI 0.86-0.89); P = 0.004]. Time to discharge from the ED was significantly longer in patients with prior CABG [359 (215-525) min vs. 300 (192-435) min; P < 0.001]. Key findings were confirmed in a large independent external validation cohort (n = 13 653).CONCLUSIONS: Patients with prior CABG presenting with suspected AMI have a high prevalence of AMI and unstable angina and lower diagnostic accuracy of CPCs and the ECG, possibly justifying liberal use of early coronary angiography in these vulnerable patients.CLINICALTRIALS.GOV REGISTRY: Number NCT00470587.
AB - AIMS: Diagnosis of acute myocardial infarction (AMI) can be challenging in patients with prior coronary artery bypass grafting (CABG).METHODS AND RESULTS: Final diagnoses were adjudicated by two independent cardiologists using the universal definition of AMI among patients presenting to the emergency department (ED) with suspected AMI. Diagnostic accuracy of 34 chest pain characteristics (CPCs) and four electrocardiogram (ECG) signatures stratified according to the presence or absence of prior CABG were prospectively quantified. Among 4015 patients (no prior CABG: n = 3686; prior CABG: n = 329), prevalence of AMI and unstable angina were higher in patients with prior CABG (35% vs. 18%; 26% vs. 8%; both P < 0.001). Three CPCs (9%) and two electrocardiographic findings (50%) showed a different diagnostic performance (interaction P < 0.05) with loss of diagnostic value in patients with prior CABG. The diagnostic accuracy as quantified by the area under the curve (AUC) of the integrated clinical judgement was moderate to good in patients with prior CABG, and significantly lower compared to patients without prior CABG [AUC 0.80 (95% confidence interval (CI) 0.75-0.84) vs. AUC 0.87 (95% CI 0.86-0.89); P = 0.004]. Time to discharge from the ED was significantly longer in patients with prior CABG [359 (215-525) min vs. 300 (192-435) min; P < 0.001]. Key findings were confirmed in a large independent external validation cohort (n = 13 653).CONCLUSIONS: Patients with prior CABG presenting with suspected AMI have a high prevalence of AMI and unstable angina and lower diagnostic accuracy of CPCs and the ECG, possibly justifying liberal use of early coronary angiography in these vulnerable patients.CLINICALTRIALS.GOV REGISTRY: Number NCT00470587.
KW - Angina, Unstable
KW - Chest Pain
KW - Coronary Artery Bypass
KW - Electrocardiography
KW - Humans
KW - Myocardial Infarction/diagnosis
U2 - 10.1093/ehjacc/zuaa020
DO - 10.1093/ehjacc/zuaa020
M3 - SCORING: Journal article
C2 - 33620434
VL - 10
SP - 746
EP - 755
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 7
ER -
