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Chest pain unit and decentralized testing of cardiac markers
I Casagranda1, R Boverio, R Baio
1Emergency Department, SS Antonio e Biagio e C.Arrigo Hospital, Alessandria, Italy. icasagranda@ospedale.al.it
Insights
Chest Pain Units (CPUs) help rule out acute coronary syndrome in emergency patients. Point-of-care testing in CPUs provides rapid, cost-effective cardiac marker results for timely diagnosis.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Chest pain is a frequent reason for Emergency Department (ED) visits, accounting for 5% of arrivals.
- Diagnosing acute coronary syndrome (ACS) promptly in patients with undifferentiated chest pain is challenging.
- Chest Pain Units (CPUs) have been proposed to improve the management of these patients.
Purpose of the Study:
- To describe the implementation and experience of a Chest Pain Unit (CPU) at Alessandria Hospital.
- To evaluate the utility of continuous ECG monitoring and serial cardiac marker testing in CPU patients.
- To assess the role of a point-of-care analyzer for rapid cardiac marker determination.
Main Methods:
- Patients presenting to the ED with undifferentiated chest pain were admitted to the CPU for continuous ECG monitoring (S-T trend for 24 h).
- Cardiac markers (myoglobin, CK-MB mass, Troponin-I) were measured on arrival and Troponin-I was serially tested at 3, 6, 9, and 18 hours.
- A point-of-care analyzer was utilized for rapid, on-site measurement of cardiac markers.
Main Results:
- The CPU facilitates the exclusion or confirmation of acute coronary syndrome through continuous monitoring and serial biomarker analysis.
- Point-of-care testing provided rapid, cost-effective results comparable to laboratory instruments.
- The analyzer was user-friendly, allowing nurses to operate it without disrupting their workflow.
Conclusions:
- Chest Pain Units are effective in managing patients with chest pain, aiding in the diagnosis of acute coronary syndrome.
- Point-of-care analyzers enhance the efficiency of cardiac marker testing in CPUs, enabling quicker clinical decisions.
- The described CPU model integrates continuous monitoring and rapid diagnostics for improved patient care.
Abstract:
Chest pain is one of the most important reasons of Emergency Department arrivals (5% of total). As it is not possible to rule-in all patients claiming chest pain, it has been proposed to create new departments to monitor these patients during some hours, in order to exclude or confirm an acute coronary syndrome. These departments are named Chest Pain Units (CPUs). The Chest Pain Unit has been created since June 1998 in Alessandria Hospital "SS. Antonio e Biagio e C. Arrigo". Chest Pain Unit patients presenting in Emergency Department with an unclear defined chest pain are submitted to a continuous ECG monitoring of S-T trend for 24 h. Moreover, cardiac markers such as myoglobin, mass CK-MB and Troponin-I are tested at arrival and Troponin-I is tested again serially 3, 6, 9, 18 h after the first sampling. It is really important to be able to measure these markers of myocardial damage with robust and quick methods. A point-of-care analyzer is available in our chest pain unit and enables our department to obtain results in a very short time at low cost and with quality similar to that of clinical chemistry laboratories' instruments. This easy-to-use analyzer can be run by nurses without interfering in their normal activities. The presentation of our experience will be completed by describing all patients admitted in our Chest Pain Units from January to June 1998.