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Clinical risk score...
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Steiro, Ole-ThomasHaukeland Hosp, Dept Heart Dis, Bergen, Norway.
(author)
Clinical risk scores identify more patients at risk for cardiovascular events within 30 days as compared to standard ACS risk criteria : the WESTCOR study
- Article/chapterEnglish2021
Publisher, publication year, extent ...
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2020-10-02
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Oxford University Press,2021
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electronicrdacarrier
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LIBRIS-ID:oai:DiVA.org:uu-446850
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-446850URI
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https://doi.org/10.1093/ehjacc/zuaa016DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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Aims Troponin-based algorithms are made to identify myocardial infarctions (MIs) but adding either standard acute coronary syndrome (ACS) risk criteria or a clinical risk score may identify more patients eligible for early discharge and patients in need of urgent revascularization. Methods and results Post-hoc analysis of the WESTCOR study including 932 patients (mean 63years, 61% male) with suspected NSTE-ACS. Serum samples were collected at 0, 3, and 8-12h and high-sensitivity cTnT (Roche Diagnostics) and cTnI (Abbott Diagnostics) were analysed. The primary endpoint was MI, all-cause mortality, and unplanned revascularizations within 30days. Secondary endpoint was non-ST-elevation myocardial infarction (NSTEMI) during index hospitalization. Two combinations were compared: troponin-based algorithms (ESC 0/3h and the High-STEACS algorithm) and either ACS risk criteria recommended in the ESC guidelines, or one of eleven clinical risk scores, HEART, mHEART, CARE, GRACE, T-MACS, sT-MACS, TIMI, EDACS, sEDACS, Goldman, and Geleijnse-Sanchis. The prevalence of primary events was 21%. Patients ruled out for NSTEMI and regarded low risk of ACS according to ESC guidelines had 3.8-4.9% risk of an event, primarily unplanned revascularizations. Using HEART score instead of ACS risk criteria reduced the number of events to 2.2-2.7%, with maintained efficacy. The secondary endpoint was met by 13%. The troponin-based algorithms without evaluation of ACS risk missed three-index NSTEMIs with a negative predictive value (NPV) of 99.5% and 99.6%. Conclusion Combining ESC 0/3h or the High-STEACS algorithm with standardized clinical risk scores instead of ACS risk criteria halved the prevalence of rule-out patients in need of revascularization, with maintained efficacy.
Subject headings and genre
Added entries (persons, corporate bodies, meetings, titles ...)
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Tjora, Hilde L.Haukeland Hosp, Emergency Care Clin, Bergen, Norway.
(author)
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Langorgen, JorundHaukeland Hosp, Dept Heart Dis, Bergen, Norway.
(author)
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Bjorneklett, RuneHaukeland Hosp, Emergency Care Clin, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
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Nygård, Ottar K.Haukeland Hosp, Dept Heart Dis, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
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Skadberg, OyvindStavanger Univ Hosp, Lab Med Biochem, Stavanger, Norway.
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Bonarjee, Vernon V. S.Stavanger Univ Hosp, Dept Cardiol, Stavanger, Norway.
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Lindahl, Bertil,1957-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)belin227
(author)
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Omland, TorbjornAkershus Univ Hosp, Div Med, Oslo, Norway.;Univ Oslo, Fac Med, Ctr Heart Failure Res, Inst Clin Med, Oslo, Norway.
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Vikenes, KjellHaukeland Hosp, Dept Heart Dis, Bergen, Norway.;Univ Bergen, Dept Clin Med, Bergen, Norway.
(author)
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Aakre, Kristin M.Univ Bergen, Dept Clin Med, Bergen, Norway.;Haukeland Hosp, Dept Med Biochem & Pharmacol, Jonas Lies Vei 65, N-5021 Bergen, Norway.
(author)
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Haukeland Hosp, Dept Heart Dis, Bergen, Norway.Haukeland Hosp, Emergency Care Clin, Bergen, Norway.
(creator_code:org_t)
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In:European Heart Journal: Oxford University Press10:3, s. 287-3012048-87262048-8734
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Steiro, Ole-Thom ...
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Tjora, Hilde L.
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Langorgen, Jorun ...
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Nygård, Ottar K.
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Skadberg, Oyvind
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