[Predictive value of chest pain score for the diagnosis of acute coronary syndromes]. / Valor predictivo de la presentación clínica del dolor torácico en el diagnóstico de los síndromes coronarios agudos.

BACKGROUND AND OBJECTIVE: We analyzed the diagnostic utility of a chest pain score in patients evaluated for chest pain of possible coronary origin. PATIENTS AND METHOD: We studied 1,068 consecutive patients coming to the emergency room with acute chest pain of possible coronary origin without ST-segment elevation, using a chest pain unit protocol. Chest pain was quantified by validated score (0-20 points). The diagnostic value of the chest pain score was analyzed for the diagnosis of acute myocardial infarction (AMI), unstable angina (UA) and acute coronary syndrome (ACS; AMI or UA). RESULTS: The diagnosis of ACS was established in 651 patients (61%), AMI in 439 (41%) and UA in 212 (20%). In the multivariate analysis a chest pain score > or = 10 was an independent predictor of ACS (odds ratio [OR] = 2.9; 95% confidence interval [CI] 2.1-4; p = 0.0001), along with an age older than 70 years (OR = 2.6; 95% CI,1.8-3.7; p = 0.0001), male gender (OR = 2; 95% CI, 1.4-2.8; p = 0.0001); insulin-dependent diabetes (OR = 2.3; 95% CI, 1.2-4.6; p = 0.016); previous myocardial infarction (OR = 1.6; 95% CI, 1.1-2.4; p = 0.022), ST depression (OR = 9.3; 95% CI, 5.2-16.7; p = 0.0001) and T wave inversion (OR = 2.5; 95% CI, 1.4-4.3; p = 0.0001). The chest pain score was associated with the diagnosis of both AMI (OR = 1.4; 95% CI, 1.1-1.9; p < 0.02) and UA (OR = 2.8; 95% CI, 1.8-4.2; p < 0.0001). CONCLUSIONS: The chest pain score allows independent information for the early diagnosis of patients coming to the emergency department with acute chest pain of possible coronary origin.

Valor predictivo de la presentación clínica del dolor torácico en el diagnóstico de los síndromes coronarios agudos / Predictive value of chest pain score for the diagnosis of acute coronary syndromes

Fundamento y objetivo: Presentamos la utilidad diagnóstica de la cuantificación del dolor torácico en pacientes con dolor torácico de posible origen coronario. Pacientes y método: Se estudió a 1.068 pacientes consecutivos que acudieron a un servicio de urgencias por dolor torácico de posible origen coronario sin elevación del segmento ST, siguiendo un protocolo de unidad de dolor torácico. El dolor torácico se cuantificó mediante un sistema de puntuación (0 a 20 puntos). Se determinó el valor diagnóstico de la puntuación de dolor torácico para predecir el diagnóstico final de infarto agudo de miocardio (IAM), angina inestable (AI) y síndrome coronario agudo (SCA; IAM o AI). Resultados: Se diagnosticó de SCA a 651 pacientes (61%), de los que 439 (41%) presentaron IAM y 212 (20%) AI. En el análisis multivariado la puntuación del dolor mayor o igual a 10 fue un predictor independiente de SCA, (odds ratio [OR] = 2,9; intervalo de confianza [IC] del 95%, 2,1-4; p = 0,0001), junto a la edad mayor o igual a 70 años (OR = 2,6; IC del 95%, 1,8-3,7; p = 0,0001), el sexo masculino (OR = 2; IC del 95%, 1,4-2,8; p = 0,0001), la diabetes insulinodependiente (OR = 2,3; IC del 95%, 1,2-4,6; p = 0,016), el infarto de miocardio previo (OR = 1,6; IC del 95%, 1,1-2,4; p = 0,022), el descenso del segmento ST (OR = 9,3; IC del 95%, 5,2-16,7; p = 0,0001) y la inversión de la onda T (OR = 2,5; IC del 95%, 1,4-4,3; p = 0,0001). La puntuación del dolor se asoció tanto al diagnóstico de IAM (OR = 1,4; IC del 95%, 1,1-1,9; p < 0,02) como de AI (OR = 2,8; IC del 95%, 1,8-4,2; p < 0,0001). Conclusiones: La cuantificación clínica del dolor torácico aporta información independiente para el diagnóstico de los pacientes que acuden al servicio de urgencias con dolor torácico de posible origen coronario

Background and objective: We analyzed the diagnostic utility of a chest pain score in patients evaluated for chest pain of possible coronary origin. Patients and method: We studied 1,068 consecutive patients coming to the emergency room with acute chest pain of possible coronary origin without ST-segment elevation, using a chest pain unit protocol. Chest pain was quantified by validated score (0-20 points). The diagnostic value of the chest pain score was analyzed for the diagnosis of acute myocardial infarction (AMI), unstable angina (UA) and acute coronary syndrome (ACS; AMI or UA). Results: The diagnosis of ACS was established in 651 patients (61%), AMI in 439 (41%) and UA in 212 (20%). In the multivariate analysis a chest pain score >= 10 was an independent predictor of ACS (odds ratio [OR] = 2.9; 95% confidence interval [CI] 2.1-4; p = 0.0001), along with an age older than 70 years (OR = 2.6; 95% CI,1.8-3.7; p = 0.0001), male gender (OR = 2; 95% CI, 1.4-2.8; p = 0.0001); insulin-dependent diabetes (OR = 2.3; 95% CI, 1.2-4.6; p = 0.016); previous myocardial infarction (OR = 1.6; 95% CI, 1.1-2.4; p = 0.022), ST depression (OR = 9.3; 95% CI, 5.2-16.7; p = 0.0001) and T wave inversion (OR = 2.5; 95% CI, 1.4-4.3; p = 0.0001). The chest pain score was associated with the diagnosis of both AMI (OR = 1.4; 95% CI, 1.1-1.9; p < 0.02) and UA (OR = 2.8; 95% CI, 1.8-4.2; p < 0.0001). Conclusions: The chest pain score allows independent information for the early diagnosis of patients coming to the emergency department with acute chest pain of possible coronary origin

[Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction]. / Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio.

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending on their comorbidity. The Charlson Index (ChI) and its adaptations are well established and widely used tools to quantify a patient comorbidity. The aim of this study is to evaluate the influence of comorbidity quantified by the ChI in the treatment administered at admission and in the pharmacological treatment prescribed at discharge in the setting of an acute myocardial infarction with and without ST segment elevation. PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospital with the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day of admission applying the ChI. According to this value patients were classified from minor to major in 2 subgroups (ChI or= 2) and differences in the admission and discharge treatments between both groups were analyzed. RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI > 2 received less frequently betablockers at discharge, but there were no significant differences in the use of ACE inhibitors, calcium channel blockers or statins. In addition they were submitted less frequently to revascularization procedures or treadmills, and no differences were found in the use of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treated with betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms; furthermore, in these patients, there were no significant differences in the use of ACE inhibitors, calcium channel blockers, thrombolytics or revascularization procedures. CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifies in-hospital and ambulatory management of patients with acute myocardial infarction. There is a lower use of invasive techniques as well as a lower prescription of betablockers at discharge in patients with greater comorbidity.

Influencia de la comorbilidad en el tratamiento intrahospitalario y al alta de los pacientes con infarto de miocardio / Influence of comorbidity on admission management and pharmacological treatment prescribed at discharge in acute myocardial infarction

FUNDAMENTO Y OBJETIVO: El tratamiento del paciente cardiológico varía según su comorbilidad. Elíndice de Charlson (ICh) y sus adaptaciones son herramientas utilizadas y contrastadas globalmenteque intentan objetivar la comorbilidad de un paciente. El objetivo del presente trabajoes evaluar la influencia de la comorbilidad, cuantificada mediante el ICh, en el tratamiento intrahospitalarioy farmacológico prescrito al alta hospitalaria en el infarto de miocardio con o sinelevación del segmento ST.PACIENTES Y MÉTODO: Se estudió a 955 pacientes consecutivos ingresados en un hospital por infartode miocardio. Se analizó la comorbilidad obtenida el primer día del ingreso mediante laaplicación del ICh, se clasificó a los pacientes en 2 subgrupos de menor o mayor comorbilidad(ICh ≤ 2; ICh > 2) y se determinó si había diferencias entre ambos subgrupos según el tratamientointrahospitalario y al alta.RESULTADOS: Los pacientes ingresados por infarto agudo de miocardio sin elevación del ST e IChsuperior a 2 recibieron con menor frecuencia bloqueadores beta al alta, mientras que no existendiferencias significativas en el tratamiento con inhibidores de la enzima de conversión de laangiotensina, antagonistas del calcio o estatinas. Además, se les practicaron menos procedimientosde revascularización y menos ergometrías, mientras que no hubo diferencias en la realizaciónde ecocardiogramas. Los pacientes con elevación del segmento ST e ICh superior a 2era menos probable que fueran tratados al alta con bloqueadores beta y estatinas, y se les realizaronmenos ergometrías y ecocardiogramas, mientras que no hubo diferencias significativasen el tratamiento con inhibidores de la enzima de conversión del la angiotensina, antagonistasdel calcio, trombólisis o tratamiento intervencionista (revascularización).CONCLUSIONES: La comorbilidad presente en el momento del ingreso y cuantificada mediante elICh condiciona de manera independiente el tratamiento intrahospitalario y el alta de los pacientescon infarto de miocardio. Hay un menor uso de técnicas invasivas, junto con una menorprescripción de bloqueadores beta al alta en los pacientes con mayor comorbilidad

BACKGROUND AND OBJECTIVE: The management of cardiac ischemic patients differs depending ontheir comorbidity. The Charlson Index (ChI) and its adaptations are well established and widelyused tools to quantify a patient comorbidity. The aim of this study is to evaluate the influenceof comorbidity quantified by the ChI in the treatment administered at admission and in thepharmacological treatment prescribed at discharge in the setting of an acute myocardial infarctionwith and without ST segment elevation.PATIENTS AND METHOD: We studied a total of 955 patients consecutively admitted in our hospitalwith the diagnosis of acute myocardial infarction. Comorbidity was obtained at the first day ofadmission applying the ChI. According to this value patients were classified from minor to majorin 2 subgroups (ChI 2) and differences in the admission and discharge treatmentsbetween both groups were analyzed.RESULTS: Patients admitted with acute myocardial infarction without ST segment elevation and ChI> 2 received less frequently betablockers at discharge, but there were no significant differences inthe use of ACE inhibitors, calcium channel blockers or statins. In addition they were submittedless frequently to revascularization procedures or treadmills, and no differences were found in theuse of echocardiograms. Patients with ST segment elevation and ChI > 2 were less frequently treatedwith betablockers or statins at discharge, and were submitted to less treadmills or echocardiograms;furthermore, in these patients, there were no significant differences in the use of ACEinhibitors, calcium channel blockers, thrombolytics or revascularization procedures.CONCLUSIONS: Comorbidity quantified on admission by the ChI is an independent factor that modifiesin-hospital and ambulatory management of patients with acute myocardial infarction.There is a lower use of invasive techniques as well as a lower prescription of betablockers atdischarge in patients with greater comorbidity