Acute Coronary Syndromes

CAD Prevalence

TIMI Calculator: http://www.mdcalc.com/timi-risk-score-for-uanstemi

TIMI Risk Index: heart rate × (age/10)²/systolic pressure

Risk Estimates for Death/MI: from www.SMARTEM.org

Low Risk <40: 1/500 death/MI 30 days

http://www.thennt.com/low-risk-chest-pain-under-age-40

non-diagnostic or normal EKG

1.) Marsan et al. Evaluation of a Clinical Decision Rule for Young Adult Patients with Chest Pain. Acad Emerg Med. 2005; 12(1): 24-31 (n=593).

2.) Walker et al. Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain. Acad Emerg Med. 2001; 8(7): 703-708 (n=312).

3.) Lee TH et al. Long-term survival of emergency department patients with acute chest pain. Am J Cardiol. 1992; 69:145–51 (n=333).

Low Risk >40: 1/250 death/MI 30 days

http://www.thennt.com/low-risk-chest-pain-over-age-40

avg 1 Framingham RF

1.) Hollander JE, et al. Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. Ann Emerg Med. 2009; 53:295-304.(n=568).

2.) Goldstein JA, et al. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863-871.

Moderate Risk: 1/125 death/MI

Avg age 50, avg 2 Framingham RF, all admitted for nuclear stress

1.) (Mahmarian et al.) = Nabi et al. Coronary Artery Calcium Scoring in the Emergency Department: Identifying Which Patients With Chest Pain Can Be Safely Discharged Home. Ann Emerg Med. 2010; 56(3): 220-9

Goldman Algorithm