Prepared by:
UCSF-Stanford Evidence-based Practice Center
Paul A. Heidenreich, M.D., M.S.
Principal Investigator
Alan Go, M.D., M.P.H.
Kathryn A. Melsop, M.S.
Thomas Alloggiamento, M.D.
Kathryn M. McDonald, M.M.
Vivian Hagan
Trevor Hastie, Ph.D.
Mark A. Hlatky, M.D.
Investigators
File Name Description Software Version File Size ________________________________________________________________________________________________ 01title.doc Microsoft Word® Document MS Word® 97 SR-1 29KB 4 pages Contents: Cover, Title Page ________________________________________________________________________________________________ 02front.doc Microsoft Word® Document MS Word® 97 SR-1 48KB 6 pages Contents: Preface, Structured Abstract, Table of Contents ________________________________________________________________________________________________ 03summ.doc Microsoft Word® Document MS Word® 97 SR-1 48KB 6 pages Contents: Summary ________________________________________________________________________________________________ 04title.doc Microsoft Word® Document MS Word® 97 SR-1 35KB 4 pages Contents: Chapter 1. Introduction ________________________________________________________________________________________________ 05method.doc Microsoft Word® Document MS Word® 97 SR-1 45KB 6 pages Contents: Chapter 2. Methodology: Prognostic Value of the History, Physical Examination, and Electrocardiogram; Prognostic Value of Troponin; Table 1. Semiquantitative grading of the relative risk, odds ratio, or rate ratio; Evaluation of Chest Pain Units and Emergency Department Protocols; Key Questions; Quality Control; Peer Review ________________________________________________________________________________________________ 06result.doc Microsoft Word® Document MS Word® 97 SR-1 70KB 20 pages Contents: Chapter 3. Results: Prognostic Value of the History, Physical Examination, and Electrocardiogram; Prognostic Value of Troponin; Evaluation of Chest Pain Units and Emergency Department Protocols ________________________________________________________________________________________________ 07figs.doc Microsoft Word® Document MS Word® 97 SR-1 208KB 10 pages Contents: Figure 1. Reasons for study exclusion, Figure 2. Risk of death: Troponin T, Figure 3. Risk of death: Troponin I, Figure 4. Risk of total death, Figure 5. Risk of cardiac death, Figure 6. Risk of death: Unstable angina patients, Figure 7. Risk of death: Chest pain patients, Figure 8. Risk of death: rapid bedside testing, Figure 9. Risk of death: non-bedside testing, Figure 10. Correlation between mortality and troponin positive risk ________________________________________________________________________________________________ 08conclu.doc Microsoft Word® Document MS Word® 97 SR-1 28KB 2 pages Contents: Chapter 4. Conclusions ________________________________________________________________________________________________ 09future.doc Microsoft Word® Document MS Word® 97 SR-1 23KB 2 pages Contents: Chapter 5. Future Research ________________________________________________________________________________________________ 10refs.doc Microsoft Word® Document MS Word® 97 SR-1 53KB 6 pages Contents: References ________________________________________________________________________________________________ 11sumtbs.doc Microsoft Word® Document MS Word® 97 SR-1 58KB 8 pages Contents: Summary Table 1. Summary findings for independent clinical and ECG predictors of adverse outcomes (death, MI, major complications): Chest pain suspicious for cardiac ischemia Summary Table 2. Summary findings for independent clinical and ECG predictors of adverse outcomes (death, MI, major complications): Diagnosed unstable angina Summary Table 3. Risk of death with positive troponin T Summary Table 4. Risk of death with positive troponin I Summary Table 5. Risk of death or MI with positive troponin T Summary Table 6. Risk of death or MI with positive troponin I Summary Table 7. Subgroup analysis of the risk of death associated with a positive troponin test Summary Table 8. Subgroup analysis of the risk of death or myocardial infarction associated with a positive troponin test in patients with unstable angina ________________________________________________________________________________________________ 12etab1.doc Microsoft Word® Document MS Word® 97 SR-1 30KB 5 pages Contents: Evidence Table 1. Study information: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 13etab2.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 1 page Contents: Evidence Table 2. Multivariate demographic predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 14etab3.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 2 pages Contents: Evidence Table 3. Multivariate medical history predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 15etab3b.doc Microsoft Word® Document MS Word® 97 SR-1 30KB 1 page Contents: Evidence Table 3b. Multivariate medical history predictors of adverse outcomes: Patients with chest pain suspicious for ischemia (continued) ________________________________________________________________________________________________ 16etab4.doc Microsoft Word® Document MS Word® 97 SR-1 27KB 1 page Contents: Evidence Table 4. Multivariate symptom predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 17etab5.doc Microsoft Word® Document MS Word® 97 SR-1 24KB 1 page Contents: Evidence Table 5. Multivariate physical examination predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 18etab6.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 1 page Contents: Evidence Table 6. Multivariate ECG predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 19etab7.doc Microsoft Word® Document MS Word® 97 SR-1 24KB 1 page Contents: Evidence Table 7. Multivariate other predictors of adverse outcomes: Patients with chest pain suspicious for ischemia ________________________________________________________________________________________________ 20etab8.doc Microsoft Word® Document MS Word® 97 SR-1 39KB 8 pages Contents: Evidence Table 8. Study information: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 21etab9.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 1 page Contents: Evidence Table 9. Multivariate demographic predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 22etab10.doc Microsoft Word® Document MS Word® 97 SR-1 28KB 1 page Contents: Evidence Table 10. Multivariate medical history predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 23etab10b.doc Microsoft Word® Document MS Word® 97 SR-1 33KB 1 page Contents: Evidence Table 10b. Multivariate medical history predictors of adverse outcomes: Patients with diagnosed unstable angina (continued) ________________________________________________________________________________________________ 24etab11.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 1 page Contents: Evidence Table 11. Multivariate symptom predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 25etab12.doc Microsoft Word® Document MS Word® 97 SR-1 26KB 1 page Contents: Evidence Table 12. Multivariate physical examination predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 26etab13.doc Microsoft Word® Document MS Word® 97 SR-1 29KB 2 pages Contents: Evidence Table 13. Multivariate ECG predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 27etab14.doc Microsoft Word® Document MS Word® 97 SR-1 27KB 2 pages Contents: Evidence Table 14. Multivariate other predictors of adverse outcomes: Patients with diagnosed unstable angina ________________________________________________________________________________________________ 28etab15.doc Microsoft Word® Document MS Word® 97 SR-1 34KB 2 pages Contents: Evidence Table 15. Demographics ________________________________________________________________________________________________ 29etab16.doc Microsoft Word® Document MS Word® 97 SR-1 36KB 3 pages Contents: Evidence Table 16. Patient characteristics (Part I) ________________________________________________________________________________________________ 30etab17.doc Microsoft Word® Document MS Word® 97 SR-1 38KB 2 pages Contents: Evidence Table 17. Patient characteristics (Part 2) ________________________________________________________________________________________________ 31etab18.doc Microsoft Word® Document MS Word® 97 SR-1 37KB 2 pages Contents: Evidence Table 18. Exclusion criteria (Part I) ________________________________________________________________________________________________ 32etab19.doc Microsoft Word® Document MS Word® 97 SR-1 37KB 2 pages Contents: Evidence Table 19. Exclusion criteria (Part 2) ________________________________________________________________________________________________ 33etab20.doc Microsoft Word® Document MS Word® 97 SR-1 33KB 2 pages Contents: Evidence Table 20. Exclusion criteria (Part 3) ________________________________________________________________________________________________ 34etab21.doc Microsoft Word® Document MS Word® 97 SR-1 31KB 2 pages Contents: Evidence Table 21. Troponin test characteristics ________________________________________________________________________________________________ 35etab22.doc Microsoft Word® Document MS Word® 97 SR-1 37KB 2 pages Contents: Evidence Table 22. Time (hours) from presentation to troponin T and troponin I tests ________________________________________________________________________________________________ 36etab23.doc Microsoft Word® Document MS Word® 97 SR-1 34KB 2 pages Contents: Evidence Table 23. Troponin T and troponin I tests threshold for positivity ________________________________________________________________________________________________ 37etab24.doc Microsoft Word® Document MS Word® 97 SR-1 34KB 2 pages Contents: Evidence Table 24. Study description ________________________________________________________________________________________________ 38etab25.doc Microsoft Word® Document MS Word® 97 SR-1 31KB 2 pages Contents: Evidence Table 25. Definition of a positive troponin result ________________________________________________________________________________________________ 39etab26.doc Microsoft Word® Document MS Word® 97 SR-1 30KB 2 pages Contents: Evidence Table 26. Myocardial infarction during admission ________________________________________________________________________________________________ 40etab27.doc Microsoft Word® Document MS Word® 97 SR-1 23KB 1 page Contents: Evidence Table 27. Deaths during admission ________________________________________________________________________________________________ 41etab28.doc Microsoft Word® Document MS Word® 97 SR-1 24KB 1 page Contents: Evidence Table 28. Composite endpoint during admission ________________________________________________________________________________________________ 42etab29.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 29. Angioplasty during admission ________________________________________________________________________________________________ 43etab30.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 30. Bypass grafting (CABG) during admission ________________________________________________________________________________________________ 44etab31.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 1 page Contents: Evidence Table 31. Myocardial infarction during followup ________________________________________________________________________________________________ 45etab32.doc Microsoft Word® Document MS Word® 97 SR-1 27KB 1 page Contents: Evidence Table 32. Death during followup ________________________________________________________________________________________________ 46etab33.doc Microsoft Word® Document MS Word® 97 SR-1 30KB 2 pages Contents: Evidence Table 33. Composite endpoint during followup ________________________________________________________________________________________________ 47etab34.doc Microsoft Word® Document MS Word® 97 SR-1 23KB 1 page Contents: Evidence Table 34. Angioplasty during followup ________________________________________________________________________________________________ 48etab35.doc Microsoft Word® Document MS Word® 97 SR-1 23KB 1 page Contents: Evidence Table 35. Bypass grafting during followup ________________________________________________________________________________________________ 49etab36.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 36. Randomized studies comparing protocols in chest pain units with routine hospital care ________________________________________________________________________________________________ 50etab37.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 37. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Baseline characteristics ________________________________________________________________________________________________ 51etab38.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 38. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Preliminary intervention protocol ________________________________________________________________________________________________ 52etab39.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 39. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Indications for admission ________________________________________________________________________________________________ 53etab40.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 40. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Patients admitted ________________________________________________________________________________________________ 54etab41.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 41. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Intervention protocol-stress testing ________________________________________________________________________________________________ 55etab42.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 42. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: early outcomes ________________________________________________________________________________________________ 56etab43.doc Microsoft Word® Document MS Word® 97 SR-1 22KB 1 page Contents: Evidence Table 43. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Death or MI ________________________________________________________________________________________________ 57etab44.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 44. Randomized studies evaluating chest pain units or accelerated diagnostic protocols: Subsequent hospitalization, physician evaluation, and emergency department visits ________________________________________________________________________________________________ 58etab45.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 45. Randomized studies comparing protocols in chest pain units with routine hospital care: Length of stay ________________________________________________________________________________________________ 59etab46.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 46. Randomized studies comparing protocols in chest pain units with routine hospital care: Cost ________________________________________________________________________________________________ 60etab47.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 47. Controlled clinical trials evaluating the use of an acute cardiac ischemia time-intensive predictive instrument ________________________________________________________________________________________________ 61etab48.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 48. Controlled clinical trials evaluating the use of an acute cardiac ischemia time-insensitive predictive instrument: Baseline characteristics ________________________________________________________________________________________________ 62etab49.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 49. Trials evaluating the use of an acute cardiac ischemia time-insensitive predictive instrument: Patients ________________________________________________________________________________________________ 63etab50.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 50. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients without acute cardiac ischemia at high-capacity cardiac care unit hospitals (N=3,335) ________________________________________________________________________________________________ 64etab51.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 51. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients without ischemia at low-capacity cardiac care unit hospitals (N=4,815) ________________________________________________________________________________________________ 65etab52.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 52. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients with stable angina in high-capacity cardiac care unit hospitals (N=300) ________________________________________________________________________________________________ 66etab53.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 53. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients with stable angina pectoris at low-capacity cardiac care unit hospitals (N=373) ________________________________________________________________________________________________ 67etab54.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 54. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients with myocardial infarction or unstable angina in high-capacity cardiac care unit hospitals (N=634) ________________________________________________________________________________________________ 68etab55.doc Microsoft Word® Document MS Word® 97 SR-1 21KB 1 page Contents: Evidence Table 55. Effect of acute cardiac ischemia time-insensitive predictive instrument on triage patients with myocardial infarction or unstable angina in low-capacity cardiac care unit hospitals (N=1,232) ________________________________________________________________________________________________ 69etab56.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 56. Effect of acute cardiac ischemia time-insensitive predictive instrument on 30-day mortality ________________________________________________________________________________________________ 70etab57.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 1 page Contents: Evidence Table 57. Effect of acute cardiac ischemia time-insensitive predictive instrument on 30-day rehospitalization ________________________________________________________________________________________________ 71etab58.doc Microsoft Word® Document MS Word® 97 SR-1 20KB 2 pages Contents: Evidence Table 58. Effect of acute cardiac ischemia time-insensitive predictive instrument on time to triage: Emergency department presentation to emergency department discharge ________________________________________________________________________________________________ 72biblio.doc Microsoft Word® Document MS Word® 97 SR-1 84KB 6 pages Contents: Bibliography ________________________________________________________________________________________________ 73appa.doc Microsoft Word® Document MS Word® 97 SR-1 32KB 6 pages Contents: Appendix A. Acknowledgments ________________________________________________________________________________________________ 74appb.doc Microsoft Word® Document MS Word® 97 SR-1 25KB 2 pages Contents: Appendix B. Research Team ________________________________________________________________________________________________ 75appc.doc Microsoft Word® Document MS Word® 97 SR-1 24KB 2 pages Contents: Appendix C. Acronyms ________________________________________________________________________________________________
AHRQ Publication No. 01-E001
Current as of December 2000
Internet Citation:
Prediction of Risk for Patients with Unstable Angina. File Inventory, Evidence Report/Technology Assessment Number 31. AHRQ Publication No. 01-E001, December 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/usanginv.htm
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