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829no1-22a-lcs
The role of
cardiovascular biomarkers
首都医科大学急诊医学系
附属北京朝阳医院急诊科
李春盛
1
Chest Pain Presentation in
Emergency Medicine
Objectives
? Discuss the complexity of presentation and the
challenges encountered with patients with signs
and symptoms of ACS and HF
? Discuss what is the value of a multimarker
strategy for diagnosis and prognosis in these
patients
The?value?of?a?multimaker?apporach?in?
the diagnosis and prognosis of? ? ? ? ?
cardiovascilar?disease
PneumoniaPneumothorax
Pulmonary Embolus
Musculoskeletal Pain
Aortic Dissection
Mondor’s
Syndrome
Tietze’s
disease
Blunt Chest Trauma
Breast Abcess
GERD
Mediastinitis
Anxiety Panic Attack
Breast Implant
Thoracic
Spine Ds
Empyema
IVDA Pulm Infarction
A h
Sickle cell
Anemia
Herpes
Zoster
Breast
Cancer
Contact
Dermatitis
Boerhave’s
Mallory-
Weiss
Lung
Cancer
Subdiaphrag
Abcess
Amniotic Fluid
Embolus
st ma
Myocardial Pain
F.W.?Peacock
If you think this is the way they look…
In 2008,
you will miss 423,600
A t M di l I f ti ’cu e yocar a n arc on s
1/3 have no chest pain
.
What about Chest Pain in MI?
? In a study of 434,877 patients with confirmed MI from
1674 US hospitals
? More than one third of all patients present
without chest pain
Canto JG et al. JAMA. 2000;283:3223-3229.
? Of these, 63.7% were UA/NSTEMI patients
? Certain MI patients such as women, elderly, and
patients with prior heart failure are more likely to
present without chest pain
Therapy vs. Chest Pain
83,2 84,5
60
80
100
%
)
No chest pain Chest pain
P0.001 P0.001 P0.001
Canto JG et al. JAMA. 2000;283:3223-3229.
53,4
60,4
26,9
59,0
0
20
40
Heparin* Aspirin or Other
Antiplatelet Agent*
Coronary
Angiography
P
at
ie
nt
s
(%
*Medication within 24 hours.
Chest Pain with AMI vs Age
? Serial markers and evocative testing
? markedly decreased adverse events
? Before-and-after study of CPC impact
? N = 4,477
? Implementation of CPC
? decreased mortality by 37%
? increased discharges 36%
Movement is Bad
Marker Comparator OR for 30 day
MACE
95% CI
↓ing Tn
vs.
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