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Acute Coronary Syndromes


CAD Prevalence

TIMI Calculator:  http://www.mdcalc.com/timi-risk-score-for-uanstemi

TIMI Risk Index: heart rate × (age/10)2/systolic pressure


Risk Estimates for Death/MI: from www.SMARTEM.org

Low Risk <40:  1/500 death/MI 30 days
non-diagnostic or normal EKG

1.) Marsan et al. Evaluation of a Clinical Decision Rule for Young Adult Patients with Chest Pain. Acad Emerg Med. 2005; 12(1): 24-31 (n=593).
2.) Walker et al. Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain. Acad Emerg Med. 2001; 8(7): 703-708 (n=312).
3.) Lee TH et al. Long-term survival of emergency department patients with acute chest pain. Am J Cardiol. 1992; 69:145–51 (n=333).

Low Risk >40:  1/250 death/MI 30 days
avg 1 Framingham RF

1.) Hollander JE, et al. Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. Ann Emerg Med. 2009; 53:295-304.(n=568). 
2.) Goldstein JA, et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863-871.

Moderate Risk:  1/125 death/MI 
Avg age 50, avg 2 Framingham RF, all admitted for nuclear stress

1.) (Mahmarian et al.) = Nabi et al. Coronary Artery Calcium Scoring in the Emergency Department: Identifying Which Patients With Chest Pain Can Be Safely Discharged Home. Ann Emerg Med. 2010; 56(3): 220-9

Goldman Algorithm



Ċ AHAACSGuidelines2010.pdf
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AHA Guidelines for Acute Coronary Syndromes, 2010  520k v. 1 Apr 25, 2011, 3:39 PM Kit Tainter
Ċ CADPrevalence(CONFIRM)-Circulation2011.pdf
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Prevalence greatly overestimated by ACC/AHA Guidelines (14,000 ED pts)    2635k v. 2 Dec 2, 2011, 7:59 AM Kit Tainter
Ċ COURAGE-NEJM2007.pdf
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PCI equal to medical therapy for stable angina  319k v. 1 May 11, 2011, 5:12 AM Kit Tainter
Ċ Exercise Stress Test Characteristics - Ann IM 1998.pdf
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814 pts, EST + cath, 45% sensitivity, 85% specificity for CAD > 50% stenosis  1046k v. 2 Feb 8, 2012, 12:28 PM Kit Tainter
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Goldman Algorithm.gif
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  59k v. 1 Apr 3, 2012, 6:44 AM Kit Tainter
Ċ HEART Score - Int J Cardio 2013.pdf
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  388k v. 1 Dec 6, 2013, 12:37 PM Kit Tainter
Ċ MIDeathInversetoCADRiskFactors-JAMA2011.pdf
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14.9%, 10.9%, 7.9%, 5.3%, 4.2%, and 3.6% for patients with 0, 1, 2, 3, 4, and 5 risk factors  221k v. 1 Dec 1, 2011, 12:22 PM Kit Tainter
Ċ Oishi-STEMIManagement.pdf
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Ċ Pope2000.pdf
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10,689 pts, 894 (8%) MI using CKMB, 19 (2%) missed MI at 24-72 hrs (0.18% overall miss rate), no stat sig diff in outcome. This is the source that is constantly referenced.  113k v. 3 Feb 4, 2012, 1:21 PM Kit Tainter
Ċ Stress Test Under 40 - Ann EM 2009.pdf
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  162k v. 1 Apr 20, 2012, 4:56 PM Kit Tainter
Ċ TIMIRiskIndex.pdf
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Ċ TIMISummary.pdf
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Ċ Troponin3hour-JAMA2011.pdf
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  258k v. 1 Jan 19, 2012, 1:35 PM Kit Tainter
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