TY - JOUR T1 - JournalScan JF - Heart JO - Heart SP - 494 LP - 496 DO - 10.1136/heart.87.5.494 VL - 87 IS - 5 AU - Iqbal Malik Y1 - 2002/05/01 UR - http://heart.bmj.com/content/87/5/494.abstract N2 - 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. ▴ Reilly BM, Evans AT, Schaider JJ, Wang Y. Triage of patients with chest pain in the emergency department: a comparative study of physicians' decisions. Am J Med2002;112:95–103. 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. ▴ Eagle KA, Goodman SG, Avezum Á, Budaj A, Sullivan CM, López-Sendón J, for the GRACE Investigators. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the global registry of acute coronary events (GRACE). Lancet2002;359:373–7. 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 … ER -