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  1. Iqbal Malik, Editor

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Failure to diagnose angina is dangerous to the patient’s health ▸ In a study of > 11 000 patients, 1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Undiagnosed patients had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36, 95% confidence interval (CI) 1.91 to 2.90) compared with those who had neither angina nor myocardial infarction throughout follow up. Those with undiagnosed angina and an abnormality on ECG (15.5%) had an increased risk of death (hazard ratio 2.37, 95% CI 1.16 to 4.87). This was similar to the rate in those with diagnosed ischaemic heart disease.

Higher risk ACS patients with troponin < 0.06 μg/l ▸ In a prospective cohort of patients with > 6 hours pain and possible acute coronary syndrome (ACS), only clinical assessment, ECG, and creatine kinase values up to 12 hours were used to make clinical decisions. Samples were stored for high sensitivity C reactive protein (CRP) and troponin T measurements. Of the patients discharged home, 382 were troponin T negative, of whom two died, two had a myocardial infarction, and seven were rehospitalised for unstable angina. A positive CRP test result (> 0.3 mg/dl) was associated with future clinical events, as was a positive test (> 13 mm/h) for erythrocyte sedimentation rate (ESR). In multivariate analyses, prior use of nitrates (hazard risk (HR) 5.9, 95% CI 1.7 to 20.1; p  =  0.004) and positive results for both CRP and ESR (HR 5.1, 95% CI 1.5 to 18.2; p  =  0.01) were independent predictors of future adverse clinical events. Event rate was 9.3% at six months with both markers positive versus 1–2% otherwise.

Postcode lottery: New York style ▸ Revascularisation after acute myocardial infarction (AMI) …

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