Navigation Links
When Chest Pain Requires Quick Action in ER

Urgency needed in only one-third of cases, study says

WEDNESDAY, May 20 (HealthDay News) -- Only one-third of the people who come to a hospital with the intense chest pain that doctors call acute coronary syndrome should be assessed for artery-opening procedures within a few hours, a new Canadian study finds.

The rest are at lower risk for a heart attack and won't be harmed by waiting a day or two, the researchers added.

There is often an issue about whether such assessment and treatment is needed quickly, said Dr. Shamir R. Mehta, director of interventional cardiology at McMaster University in Ontario and lead author of a report in the May 21 issue of the New England Journal of Medicine. "Settling this issue is very important, and that is why the study was done."

Acute coronary syndrome may mean "anything from a threatened heart attack all the way to a full-blown heart attack," Mehta said. "If it is not a full-blown heart attack, the patient may respond to medication, and we can wait a couple of days for it to stabilize."

The study included 3,031 people with acute coronary syndrome. Half were randomly assigned to get early assessment of coronary artery blockage followed by an artery-opening procedure if necessary -- on average, within 14 hours -- and the other half waited an average of 50 hours for such treatment. After six months, the incidence of death, heart attacks or stroke wasn't that different in the two groups -- 9.6 percent of those who had early intervention, 11.3 percent among those who waited.

But analysis of the results showed that the benefit was concentrated among those people who were graded as being at highest risk on a scale that included such factors as age, blood pressure and presence of biomarkers of heart injury. So the bottom line, Mehta said, is that "it is OK to wait unless you are at high risk."

The finding is useful in several practical ways, he said. For one, it helps settle a debate about whether early intervention might be harmful in some cases. "The study showed that early intervention does not increase the risk," Mehta said.

And then the findings can be applied to the not uncommon scenario when emergency department doctors have to deal with acute coronary syndrome at an awkward time or place -- late on Friday in a busy city hospital, for example.

"If you show up at 10 in the morning on Tuesday, you can have an angiography [which shows the extent of heart damage] by Tuesday afternoon," Mehta said. "If it is 10 p.m. on Friday, the vast majority of U.S. hospitals will not have an angiogram until Monday."

A judgment about whether quick treatment is needed can be made without much delay, said Dr. Richard A. Lange, vice chair of medicine at The University of Texas Health Science Center in San Antonio, and co-author of an editorial accompanying the study. "Most of the information can be gathered quickly, certainly by the time a patient is admitted to the intensive care unit," Lange said.

The issues with acute coronary syndrome start with "how intensive medical [drug] therapy should be," Lange said. "Then there is the question of whether the patient should go to the cath lab at all, or urgently. Those individuals who don't have many of the risk factors can receive less intensive treatment."

"Cath lab" is medical jargon for the hospital unit that does a coronary assessment by threading the thin tube called a catheter into a heart artery.

When the indicators show that someone is not at high risk, "you give intensive medical treatment and then go to the cath lab," Lange said. "For those at highest risk, you go right to the cath lab."

"The study showed that the majority of patients are not high risk," Mehta said. "They can go for angiography early or later."

More information

Acute coronary syndrome is described by the American Heart Association.

SOURCES: Shamir R. Mehta, M.D., associate professor, medicine, and director, interventional cardiology, McMaster University, Hamilton, Canada; Richard A. Lange, M.D., vice chair, medicine, University of Texas Health Science Center, San Antonio; May 21, 2009, New England Journal of Medicine

Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Study: Women with hard to diagnose chest pain symptoms at higher risk for cardiovascular events
2. Rochester Medical Reports Second Quarter Results
3. Excluding the lateral view in chest radiograph screenings decreases radiation exposure by 67 percent
4. Rochester Medical Announces Second Quarter 2009 Earnings Conference Call April 30, 2009
5. Journal Chest: April news briefs
6. SunGard Availability Services Partners with Orchestrate Healthcare to Improve Availability of Electronic Medical Records
7. Hondros College School of Nursing West Chester Campus Opens New Building; Honors Nursing Administrators
8. High-Tech Meets Luxury at New Dental Practice: Introducing Westchester Smile Design
9. Journal Chest: March news briefs
10. Computer-aided system effectively detects and measures pneumothoraces in chest trauma patients
11. Rochester Medical Renews Share Repurchase Activity
Post Your Comments:
Related Image:
When Chest Pain Requires Quick Action in ER
(Date:11/25/2015)... ... , ... On November 10, 2015, Bohrer Brady, LLC filed a class and ... a home health care worker who provided companionship services for the elderly, ill or ... by Humana, Inc., Humana at Home, Inc., and SeniorBridge Family Companies (CT), Inc. since ...
(Date:11/25/2015)... ... November 25, 2015 , ... According to an article published ... and more widely heralded as a breakthrough for performing hernia repairs. The article explains ... laparoscopic surgery is that it can greatly reduce the pain that a patient might ...
(Date:11/25/2015)... ... November 25, 2015 , ... Dental professionals who would like to become ... invited to attend Dr. Mark Iacobelli’s Advanced Implant Mentoring (AIM) CE course. Courses will ... , As the co-founders of Advanced Implant Mentoring (AIM), Dr. Iacobelli and Dr. D’Orazio ...
(Date:11/25/2015)... ... November 25, 2015 , ... ... athletic programs, launches new Wimbledon Athletics Facebook page to educate the ... for unsuspected cardiac abnormalities. About 2,000 people under the age of 25 die ...
(Date:11/25/2015)... ... November 25, 2015 , ... On November 23rd 2015 Cozy ... personal heating products business. Cozy Products explains what this means for business moving ... well with the Cozy Products business model: to sell personal heaters that reduce energy ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... N.Y. , Nov. 25, 2015  Henry Schein, ... and services to office-based dental, medical and animal health ... (GNYDM) Meeting the Henry Schein ConnectDental® Pavilion , ... broadest array of open solutions designed to help any ... Click here for a schedule of experts ...
(Date:11/25/2015)... issue of United States patent No. 9,192,509  entitled: " Methods and Apparatus ... AVACEN 100 dry heat therapy medical device and specific methods of use, referred to by the ... - ... ... ...
(Date:11/25/2015)... YORK , November 25, 2015 ... market of self-monitoring blood glucose devices was valued at ... grow with a CAGR of 5.7% during 2015 - ... geriatric population and increasing prevalence of diabetes. In addition, ... diabetes care is also contributing to the growth of ...
Breaking Medicine Technology: