Author + information
- Lionel Junior Malebranche,
- Amratash Malodiya,
- David Dang,
- Jaya Bathina,
- Donna Mahoney,
- Angela Hoban,
- Paul Kolm,
- William Weintraub and
- Ehsanur Rahman
It has been shown that shorter door to balloon time in patients with ST Elevation Myocardial Infarction(STEMI) is associated with lower mortality. However, in an attempt to progressively decrease door to balloon time, there may be an increasing incidence of the number of patients going for emergent angiography who don't have acute obstructive coronary artery disease, especially in patients with acute pericarditis.
At our regional academic medical center, a retrospective review of the records from January 1st 2006-December 31st 2010 of consecutive patients suspected of having STEMI was performed. 1664 patients were suspected of possible STEMI with 1097 patients taken emergently for coronary angiography after evaluation by a cardiologist
Of the 1097 patients, 104 patients were found to have no significant obstructive coronary disease (i.e. no culprit lesion). Of these 104 (9.4%) patients, 31 patients were discharged with the diagnosis of pericarditis. Of the remaining 567 patients who didn't go for emergent angiography, 16/567 (2.8%) were discharged with the diagnosis of pericarditis. The total number of pericarditis among those that had STE was thus 47 with 31/47(66%) needing emergent angiography to definitively rule out STEMI. Troponin level was drawn on presentation to the ED but the results were not available when the patients went to the catheterization lab. Upon looking back at those who underwent emergent angiography, 13/31(41.9%) patients had elevated initial troponin T level (N=0.00-0.03) and 18/31(58.1%) patients had no initial elevation. Adjusted for elevated creatinine, the probability of pericarditis diagnosis in patients with elevated troponin was 0.42 and 0.41 in patients with non-elevated troponin (p = 0.682).
Of the patients with acute pericarditis, a high percentage (66%) required emergent angiography to rule out acute STEMI. Availability of troponin results on admission would not have prevented an emergent angiography from being performed because troponin may be almost equally elevated or normal in pericarditis.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pericardial Diseases
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1250-148
- 2013 American College of Cardiology Foundation