Ischaemic heart disease

Improving triage of chest pain: man and computer combined? ▸ In US studies, 2% of acute myocardial infarction (MI) and 2% of unstable angina patients are wrongly triaged as low risk and sent home. These patients suffer a 1.9× higher mortality than those treated appropriately. This study compared physicians to a computer model for 20 simulated scenarios. The experience level of physicians did not affect performance, and all were more cautious than the model, leading to lower sensitivity (85% v 96%, p = 0.02). However, physicians sent home 2.4% of patients when complications would have occurred versus 0.6% for the model. Physicians may be able to use the model, combined with biochemical markers, to improve their performance. Since the model requires a history to be properly taken, the physician has not (yet) become redundant.

30% of patients with ST elevation MIs miss out on treatment ▸ A multinational registry found that, of 1763 patients with ST elevation MI (STEMI) presented within 12 hours of symptom onset, 30% did not receive appropriate reperfusion treatment. Mortality was 5% with treatment and 10% without. In hospitals with catheter labs, 19% of cases had angioplasty (these centres were almost all in the USA). This registry confirms that the older patient, the diabetic, and those with previous grafts miss out on thrombolysis.

Gp IIb/IIIa blockers reduce 30 day mortality by 1% in ACS ▸ This is a meta-analysis of the use of glycoprotein (Gp) IIb/IIIa blockers in over 30 000 patients with acute coronary syndromes (ACS). Overall 30 day mortality has been reduced from 11.8% to 10.8% by treatment (relative risk reduction 0.91, p = 0.015). The same risk reduction is present in most patient groups, with those at highest risk gaining most benefit. Bleeding was increased from 1.4% to 2.4% (p < 0.0001), but …