Prospective evaluation of an EDB-based diagnostic program to be used in patients admitted to hospital with acute chest pain

A recently designed computer based decision support system (DSP),almost exclusively based on case history data, was developedto facilitate immediate differentiation between patients withand without urgent need for coronary care unit (CCU) transferralfrom the emergency room, and additionally to distinguish betweenpatients with and without acute myocardial infarction (MI). One-year's prospective testing in a consecutive series of 1252patients with acute chest pain revealed that the DSP, used inaddition to ECG and clinical examination, demonstrated a sensitivityof 96% in the detection of patients in need of CCU observation(MI-sensitivity of 98%), and a specificity of 56% in excludingpatients who were not in need of CCU observation. The proportionof referrals to the CCU judged to be unnecessary was only 17%of the total number of patients seen in the emergency room.     

Rapid and correct diagnosis of myocardial infarction: standardized case history and clinical examination provide important information for correct referral to monitored beds

Abstract. The value of thorough examination of the case history as a diagnostic tool on hospitalization of patients with suspected myocardial infarction was investigated in three independent prospective studies. Use of a limited number of pain-related elements (= ‘criteria’), that had already been obtained in the emergency room, could improve the decision on whether or not to admit patients to the coronary-care unit. As an example, in one of the studies, use of such criteria would have reduced the number of ‘unnecessary’ coronary-care-unit admissions from 298 to 162, a 46% reduction (P < 0.001). In the same patient sample, use of the criteria could have reduced the number of patients with definite acute myocardial infarction, admitted to the general wards, from 47 to 22, a 53% reduction (P < 0.01). These favourable results were confirmed in the two independent, smaller-scale studies.     

Congestive Heart Failure and Ejection Fraction in Acute Myocardial Infarction

ABSTRACT Left ventricular ejection fraction (EF) was determined by means of radionuclide ventriculography (RNV) in 477 patients 8-12 days after an acute myocardial infarction (AMI). EF was correlated to infarct size and clinical and radiological parameters of congestive heart failure (CHF). The 138 patients (29%) who had signs of CHF had a mean (±SD) EF of 35 ±14% and a relative heart volume of 597 ±112 ml/m¹ compared to 51 ±14% and 487±88 ml/m² among those without CHF. The 52 patients who also had radiological signs of CHF had a mean EF of 27±12% versus 35±14% among those with clinical signs and symptoms of CHF. Presence of CHF was positively correlated to the size of AMI and to the reduction of EF. CHF was seen with increasing frequency from 16% in small to 46% in large first infarctions. Patients with reinfarctions showed the same correlation between these parameters, however, with subsequently more depressed EF values and more frequent presence of CHF due to previous myocardial damage. CHF was seldom (8%) observed in patients with EF>50%. In contrast, 67% of the patients with EF<35% had CHF. Thus patients with an EF<35% represent a high risk group with regard to development of CHF and should be followed closely. It is suggested that radionuclide measurement of EF adds important clinical information in patients with diagnostic uncertainty of CHF.