Biomedical subjects
Thomas P Noeller
Publications and source records attributed to Thomas P Noeller.
Troponin T in elders with suspected acute coronary syndromes.
Troponin T (TnT) elevations (> or =0.1 ng/mL) indicate an increased risk of adverse outcomes in patients with acute coronary syndromes (ACS). There is little data on the prognostic significance of TnT in elders with ACS. We sought to define the ability of TnT to predict adverse outcomes in elders with suspected ACS compared with the younger cohort. This is a nested cohort study of patients aged <65 and > or =65 years with suspected ACS. Serial ECGs, CKMB and TnT assays were obtained at presentation and 4, 8, and 16 hours later. Adverse outcomes at hospital discharge included death, nonfatal myocardial infarction, coronary artery bypass grafting, and positive cardiac catheterization. A total of 695 patients were enrolled. A total of 301 (48%) were aged 65 or older. Although there was no difference in TnT sensitivity between the younger and older cohorts, there was a difference in specificity, 94% versus 83% (P <.01), respectively. In both cohorts, renal insufficiency was associated with a significantly lower TnT specificity. In both elders and younger patients with abnormal renal function, low TnT specificity warrants careful consideration of this marker as the sole criterion for aggressive medical management.
Short-term risk after initial observation for chest pain.
Few studies have evaluated the necessity of immediate stress testing after observation for chest pain. The purpose of this study was to assess the safety of outpatient stress testing after discharge from a chest pain unit. We hypothesized that discharge from a chest pain unit before stress testing is associated with a low rate of short-term adverse outcomes. This was a retrospective chart review of managed care patients discharged from the chest pain unit before the performance of stress testing. Records were reviewed for the occurrence of adverse cardiac outcomes before an outpatient stress test up to 60 days post-discharge. Primary outcomes were defined as death or myocardial infarction, and secondary outcomes as readmission for chest pain evaluation, unstable angina, or congestive heart failure. Three hundred forty-four patients were identified. One hundred sixty-six patients had either a recent prior stress test (17) or an outpatient test (149) performed within 60 days of discharge. During that time, 2 patients (0.6%) had a fatal out-of-hospital cardiac event, and there were 27 subsequent chest pain visits to the Emergency Department by 24 patients (7.0%). Nine patients (2.6%) were admitted to the hospital and 10 (2.9%) were readmitted to the observation unit for chest pain. We conclude that patients who have negative serial electrocardiograms and enzyme testing in a chest pain unit are at low risk for short-term cardiac events. Appropriately selected patients may be discharged for subsequent outpatient testing.