The utility of capnography in determining the risk of major cardiac adverse events in patients with atypical chest pain.

INTRODUCTION: Various scoring systems have been developed to safely rule out the diagnosis of acute coronary syndrome. Furthermore, the efficacy of these scoring systems in predicting the risk of major adverse cardiac events (MACE) is debated. Our aim was to compare parameters such as Integrated Pulmonary Index (IPI) and End Tidal Carbon Dioxide (etCO2) measured in the emergency department with the HEART score in terms of its success in predicting the risk of major adverse cardiac events. METHOD: Patients with atypical chest pain were registered for the study by the emergency room physician. The patients were investigated regarding gender, age, background characteristics, prognostic accuracy of etCO2, IPI, MACE, and HEART scores. RESULTS: As a result of the analysis, higher HEART Score and lower etCO2 values were determined in the MACE group compared to the group without MACE. ROC analysis was performed to determine the power of IPI, HEART Score, and etCO2 to predict MACE. The findings revealed that IPI significantly predicted MACE with an AUC value of 0.737. CONCLUSION: In our study, although the highest sensitivity values in determining the risk of 30-day MACE belonged to the HEART score, etCO2 and IPI might be other parameters that could be used to determine the risk of 30-day MACE.

Prevalence, Risk Factors, Prognosis, and Management of Pericardial Effusion in COVID-19.

Background: There is limited data in the literature about the clinical importance and prognosis of pericardial effusion (PE) in patients discharged after recovering from COVID-19, but large-scale studies have yet to be available. This study investigated the prevalence, risk factors, prognosis, late clinical outcomes, and management of PE in COVID-19. Materials and Methods: Between August 2020 and March 2021, 15,689 patients were followed up in our pandemic hospital due to COVID-19. Patients with positive polymerase chain reaction (PCR) test results and PE associated with COVID-19 in computed tomography (CT) were included in the study. The patients were divided into three groups according to PE size (mild, moderate, and large). Transthoracic echocardiography (TTE) records, laboratory data, clinical outcomes, and medical treatments of patients discharged from the hospital were retrospectively reviewed. Results: According to the PE size (mild, moderate, large) of 256 patients with PE at admission or discharge, the mean age was 62.17 ± 16.34, 69.12 ± 12.52, and 72.44 ± 15.26, respectively. The mean follow-up period of the patients was 25.2 ± 5.12 months. Of the patients in the study population, 53.5% were in the mild group, 30.4% in the moderate group, and 16.1% in the large group. PE became chronic in a total of 178 (69.6%) patients at the end of the mean three months, and chronicity increased as PE size increased. Despite the different anti-inflammatory treatments for PE in the acute phase, similar chronicity was observed. In addition, as the PE size increased, the patients' frequency of hospitalization, complications, and mortality rates showed statistical significance between the groups. Conclusions: The clinical prognosis of patients presenting with PE was quite poor; as PE in size increased, cardiac and noncardiac events and mortality rates were significantly higher. Patients with large PE associated with COVID-19 at discharge should be monitored at close intervals due to the chronicity of PE and the increased risk of tamponade.