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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.