Improved outcome in acute coronary syndrome by establishing a chest pain unit
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Improved outcome in acute coronary syndrome by establishing a chest pain unit. / Keller, Till; Post, Felix; Tzikas, Stergios; Schneider, Astrid; Arnolds, Sven; Scheiba, Oliver; Blankenberg, Stefan; Münzel, Thomas; Genth-Zotz, Sabine.
in: CLIN RES CARDIOL, Jahrgang 99, Nr. 3, 03.2010, S. 149-155.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Improved outcome in acute coronary syndrome by establishing a chest pain unit
AU - Keller, Till
AU - Post, Felix
AU - Tzikas, Stergios
AU - Schneider, Astrid
AU - Arnolds, Sven
AU - Scheiba, Oliver
AU - Blankenberg, Stefan
AU - Münzel, Thomas
AU - Genth-Zotz, Sabine
PY - 2010/3
Y1 - 2010/3
N2 - AIMS: Chest pain units (CPUs) have been established to optimize treatment of patients with acute coronary syndrome (ACS) and to early and accurately discharge patients with non-coronary chest pain. The aim of this analysis was to elucidate whether treatment of ACS patients in the CPU versus emergency department (ED) has prognostic implications.METHODS AND RESULTS: Patients presenting with suspected ACS to either the ED between August 2004 and June 2005 or the CPU between July 2005 and May 2006 were retrospectively analyzed. Of 1,796 included patients, 483 had the discharge diagnosis ACS. When compared to patients with exclusion of ACS they had more cardiovascular risk factors and higher troponin, creatinine and C-reactive protein levels (P < 0.001) at admission. Within 1 year, 37 patients of the ACS group suffered an event. Treatment in the ED compared with the CPU showed a significant increase in hazard ratio of 2.1 (P = 0.034) for the combined endpoint death, myocardial infarction and stroke, remaining unchanged after adjusting for confounders. Event-free 1-year survival was higher in CPU patients for the combined endpoint (P (logrank) = 0.02).CONCLUSION: These results demonstrate a better 1-year prognosis for ACS patients treated in the CPU instead of the ED, therefore, supporting the idea to establish CPUs in Europe.
AB - AIMS: Chest pain units (CPUs) have been established to optimize treatment of patients with acute coronary syndrome (ACS) and to early and accurately discharge patients with non-coronary chest pain. The aim of this analysis was to elucidate whether treatment of ACS patients in the CPU versus emergency department (ED) has prognostic implications.METHODS AND RESULTS: Patients presenting with suspected ACS to either the ED between August 2004 and June 2005 or the CPU between July 2005 and May 2006 were retrospectively analyzed. Of 1,796 included patients, 483 had the discharge diagnosis ACS. When compared to patients with exclusion of ACS they had more cardiovascular risk factors and higher troponin, creatinine and C-reactive protein levels (P < 0.001) at admission. Within 1 year, 37 patients of the ACS group suffered an event. Treatment in the ED compared with the CPU showed a significant increase in hazard ratio of 2.1 (P = 0.034) for the combined endpoint death, myocardial infarction and stroke, remaining unchanged after adjusting for confounders. Event-free 1-year survival was higher in CPU patients for the combined endpoint (P (logrank) = 0.02).CONCLUSION: These results demonstrate a better 1-year prognosis for ACS patients treated in the CPU instead of the ED, therefore, supporting the idea to establish CPUs in Europe.
KW - Acute Coronary Syndrome/diagnosis
KW - Adult
KW - Aged
KW - C-Reactive Protein/metabolism
KW - Cardiology Service, Hospital/organization & administration
KW - Chest Pain/diagnosis
KW - Creatinine/metabolism
KW - Emergency Service, Hospital/organization & administration
KW - Female
KW - Follow-Up Studies
KW - Germany
KW - Humans
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Retrospective Studies
KW - Risk Factors
KW - Survival Rate
KW - Treatment Outcome
KW - Troponin/metabolism
U2 - 10.1007/s00392-009-0099-9
DO - 10.1007/s00392-009-0099-9
M3 - SCORING: Journal article
C2 - 20033695
VL - 99
SP - 149
EP - 155
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 3
ER -