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The Elder Patient with Suspected Acute Coronary Syndromes in the Emergency Department

2007; Wiley; Volume: 14; Issue: 8 Linguagem: Inglês

10.1111/j.1553-2712.2007.tb01871.x

1553-2712

Jin H. Han, Christopher J. Lindsell, Richard Hornung, T. Lewis, Alan B. Storrow, James W. Hoekstra, Judd E. Hollander, Chadwick D. Miller, W. Frank Peacock, Charles V. Pollack, W. Brian Gibler,

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Academic Emergency MedicineVolume 14, Issue 8 p. 732-739 Free Access The Elder Patient with Suspected Acute Coronary Syndromes in the Emergency Department Jin H. Han MD, MSc, Corresponding Author Jin H. Han MD, MSc Department of Emergency Medicine, Vanderbilt University Medical Center Contact for correspondence: Jin H. Han, MD (Email: jin.h.han@vanderbilt.edu).Search for more papers by this authorChristopher J. Lindsell PhD, Christopher J. Lindsell PhD Nashville, TN; Departments of Emergency MedicineSearch for more papers by this authorRichard W. Hornung DrPH, Richard W. Hornung DrPH Department of Pediatrics, Cincinnati Children's Hospital Cincinnati, OHSearch for more papers by this authorTimothy Lewis MD, Timothy Lewis MD Internal Medicine University of Cincinnati, Cincinnati, OHSearch for more papers by this authorAlan B. Storrow MD, Alan B. Storrow MD Department of Emergency Medicine, Vanderbilt University Medical CenterSearch for more papers by this authorJames W. Hoekstra MD, James W. Hoekstra MD Department of Emergency Medicine, Wake Forest University Winston-Salem, NCSearch for more papers by this authorJudd E. Hollander MD, Judd E. Hollander MD Department of Emergency Medicine, University of Pennsylvania Philadelphia, PASearch for more papers by this authorChadwick D. Miller MD, Chadwick D. Miller MD Department of Emergency Medicine, Wake Forest University Winston-Salem, NCSearch for more papers by this authorW. Frank Peacock MD, W. Frank Peacock MD Department of Emergency Medicine, Cleveland Clinic Foundation Cleveland, OHSearch for more papers by this authorCharles V. Pollack MD, MA, Charles V. Pollack MD, MA Department of Emergency Medicine, University of Pennsylvania Philadelphia, PASearch for more papers by this authorW. Brian Gibler MD, W. Brian Gibler MD Nashville, TN; Departments of Emergency MedicineSearch for more papers by this author Jin H. Han MD, MSc, Corresponding Author Jin H. Han MD, MSc Department of Emergency Medicine, Vanderbilt University Medical Center Contact for correspondence: Jin H. Han, MD (Email: jin.h.han@vanderbilt.edu).Search for more papers by this authorChristopher J. Lindsell PhD, Christopher J. Lindsell PhD Nashville, TN; Departments of Emergency MedicineSearch for more papers by this authorRichard W. Hornung DrPH, Richard W. Hornung DrPH Department of Pediatrics, Cincinnati Children's Hospital Cincinnati, OHSearch for more papers by this authorTimothy Lewis MD, Timothy Lewis MD Internal Medicine University of Cincinnati, Cincinnati, OHSearch for more papers by this authorAlan B. Storrow MD, Alan B. Storrow MD Department of Emergency Medicine, Vanderbilt University Medical CenterSearch for more papers by this authorJames W. Hoekstra MD, James W. Hoekstra MD Department of Emergency Medicine, Wake Forest University Winston-Salem, NCSearch for more papers by this authorJudd E. Hollander MD, Judd E. Hollander MD Department of Emergency Medicine, University of Pennsylvania Philadelphia, PASearch for more papers by this authorChadwick D. Miller MD, Chadwick D. Miller MD Department of Emergency Medicine, Wake Forest University Winston-Salem, NCSearch for more papers by this authorW. Frank Peacock MD, W. Frank Peacock MD Department of Emergency Medicine, Cleveland Clinic Foundation Cleveland, OHSearch for more papers by this authorCharles V. Pollack MD, MA, Charles V. Pollack MD, MA Department of Emergency Medicine, University of Pennsylvania Philadelphia, PASearch for more papers by this authorW. Brian Gibler MD, W. Brian Gibler MD Nashville, TN; Departments of Emergency MedicineSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2007.04.008Citations: 18AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract ObjectivesTo describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). MethodsThis was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i∗trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients. ResultsA total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients. 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