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Influence of previous coronary artery bypass grafting in the difficulty of acute coronary syndrome diagnosis

Miró, Òscar and Martínez-Nadal, Gemma and Koechlin, Luca and Coll-Vinent, Blanca and Gil, Víctor and Aguiló, Sira and Galicia, Miguel and García-Martínez, Ana and Ortega, Mar and Strebel, Ivo and Ayala, Pedro López and Gualandro, Danielle M. and Boeddinghaus, Jasper and Nestelberger, Thomas and Bragulat, Ernest and Sánchez, Miquel and Müller, Christian and López-Barbeito, Beatriz. (2021) Influence of previous coronary artery bypass grafting in the difficulty of acute coronary syndrome diagnosis. European Journal of Emergency Medicine, 28 (2). pp. 125-135.

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Official URL: https://edoc.unibas.ch/86697/

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Abstract

To investigate whether the diagnosis of acute coronary syndrome (ACS) in coronary artery bypass grafting (CABG) patients with chest pain (CP) is more difficult based on the initial clinical and electrocardiogram (ECG) findings.; We included consecutive CP patients attended at a single emergency department (ED) during a 10-year period. CABG status and the final diagnosis of ACS were considered as stated in the ED discharge report. We evaluated the frequency of 21 CP characteristics (CPC) and four ECG signatures, their individual and collective association with ACS, and ED length of stay (LOS) in CABG and non-CABG patients.; We included 34 429 patients [median age: 61 years; female: 41.8%; CABG: 2204 patients (6.4%)], and ACS was diagnosed in 6727 (19.5%; CABG/non-CABG 37.2%/18.3%; P < 0.001). CABG patients more frequently had CPC and ECG findings typically associated with ACS, but their final association with ACS was weaker than in non-CABG patients (only significant after adjustment for attendant diaphoresis, throat irradiation, ST-segment elevation and T-wave inversion). The collective discriminative capacity was significantly lower in CABG patients (area under the curve 0.710 vs. 0.793; P < 0.001), even after adjustment (0.708 vs. 0.790; P < 0.001). ED LOS was longer for CABG patients, overall (P < 0.001) and for patients diagnosed with ACS (P = 0.008) and non-ACS (P < 0.001), but these differences disappeared after adjustment.; CABG substantially reduces the diagnostic performance of CPC and ECG findings to suggest ACS. A longer LOS in the ED in CABG patients is more related to their baseline characteristics than to CABG itself.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Miro, Oscar and Koechlin, Luca and Strebel, Ivo and Gualandro, Danielle and Lopez Ayala, Pedro and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:0969-9546
e-ISSN:1473-5695
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:26 Apr 2023 10:07
Deposited On:26 Apr 2023 10:07

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