Register for email alerts and news feeds:
This journal | BMJ Group
rss
Heart 2001;85:143-148; doi:10.1136/heart.85.2.143
Copyright © 2001 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2001;85:143-148 ( February )

Cardiovascular medicine

Safe discharge from the cardiac emergency room with a rapid rule-out myocardial infarction protocol using serial CK-MBmass R Bholasingh, R J de Winter, J C Fischer, R W Koster, R J G Peters, G T Sanders

Department of Cardiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands

Correspondence to: Dr Bholasingh r.bholasingh{at}amc.uva.nl

Accepted 12 September 2000

OBJECTIVE---To determine whether a new protocol, using a rapid and sensitive CK-MBmass assay and serial sampling, can rule out myocardial infarction in patients with chest pain and decrease their length of stay in the cardiac emergency room without increasing risk.
DESIGN---The combined incidence of cardiac death and acute myocardial infarction at 30 days, six months, and 24 months of follow up were compared between patients discharged home from the cardiac emergency room after ruling out myocardial infarction with a CK-MBactivity assay in 1994 and those discharged home after a rapid CK-MBmass assay in 1996.
SETTING---Cardiac emergency room of a large university hospital.
PATIENTS---In 1994 and 1996, 230 and 423 chest pain patients, respectively, were discharged home from the cardiac emergency room with a normal CK-MB and an uneventful observation period.
RESULTS---The median length of stay in the cardiac emergency room was significantly reduced, from 16.0 hours in 1994 to 9.0 hours in 1996 (p < 0.0001). Mean event rates in patients from the 1994 and 1996 cohorts, respectively, were 0.9% (95% confidence interval (CI) -0.3% to 2.1%) v 0.7% (95% CI -0.1% to 1.5%) at 30 days, 3.0% (95% CI 0.8% to 5.2%) v 2.8% (95% CI 1.2% to 4.4%) at six months, and 7.0% (95% CI 3.7% to 10.3%) v 5.7% (95% CI 3.5% to 7.9%) at 24 months. Kaplan-Meier survival analysis showed no difference in mean event-free survival at 30 days, six months, and 24 months of follow up.
CONCLUSIONS---Using a rule-out myocardial infarction protocol with a rapid and sensitive CK-MBmass assay and serial sampling, the length of stay of patients with chest pain in the cardiac emergency room can be reduced without compromising safety.


Keywords: length of stay; cardiac emergency room; creatine kinase-MB; myocardial infarction

© 2001 by Heart
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Arnold, J., Goodacre, S., Morris, F., on behalf of the ESCAPE Research Team, (2007). Structure, process and outcomes of chest pain units established in the ESCAPE Trial. Emerg. Med. J. 24: 462-466 [Abstract] [Full Text]  
  • Leu, H.-B., Lin, C.-P., Lin, W.-T., Wu, T.-C., Chen, J.-W. (2004). Risk Stratification and Prognostic Implication of Plasma Biomarkers in Nondiabetic Patients With Stable Coronary Artery Disease: The Role of High-Sensitivity C-Reactive Protein. Chest 126: 1032-1039 [Abstract] [Full Text]  
  • Bholasingh, R., Cornel, J. H., Kamp, O., van Straalen, J. P., Sanders, G. T., Tijssen, J. G. P., Umans, V. A. W. M., Visser, C. A., de Winter, R. J. (2003). Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T. J Am Coll Cardiol 41: 596-602 [Abstract] [Full Text]  

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Show me all >>