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Article ; Online: Serum adiponectin levels in patients with acute coronary syndromes: Serial changes and relation to infarct size.

Alkofide, Hadeel / Huggins, Gordon S / Ruthazer, Robin / Beshansky, Joni R / Selker, Harry P

2015 Volume 12, Issue 6, Page(s) 411–419

Abstract: Background: The role of adiponectin in patients with acute coronary syndromes is incompletely defined. This study investigated adiponectin levels in patients with acute coronary syndromes and the association between adiponectin and 30-day infarct size ... ...

Abstract	Background: The role of adiponectin in patients with acute coronary syndromes is incompletely defined. This study investigated adiponectin levels in patients with acute coronary syndromes and the association between adiponectin and 30-day infarct size and 1-year clinical outcomes. Methods: Retrospective analysis of 120 participants with acute coronary syndromes enrolled in the Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial. Blood levels were tested three times within 24 h of onset of ischaemic symptoms. Infarct size was measured at 30 days. The 1-year clinical outcome was the composite of all-cause mortality or hospitalization for heart failure. Results: Using linear mixed models, log adiponectin levels decreased by -0.005 µg/mL per hour (p = 0.035). After stratifying the analysis by gender, there was no decrease in log adiponectin in men; however, levels decreased by -0.01 µg/mL per hour in women (p = 0.02). Results of multivariable regression models showed no association between log adiponectin and infarct size (β = -1.1, p = 0.64). Log adiponectin levels did not predict 1-year outcomes using Cox-proportional hazard models. Conclusion: There was a small decrease in plasma adiponectin shortly after symptoms of ischaemia, more noticeable in women. No relationship was found between adiponectin and infarct size or clinical outcomes. This adds to evidence showing no clear association between adiponectin and adverse outcomes in patients with acute coronary syndromes.
MeSH term(s)	Acute Coronary Syndrome/blood ; Acute Coronary Syndrome/complications ; Acute Coronary Syndrome/diagnosis ; Adiponectin/blood ; Adult ; Aged ; Aged, 80 and over ; Electrocardiography/methods ; Female ; Heart Failure/blood ; Humans ; Male ; Middle Aged ; Myocardial Infarction/blood ; Myocardial Infarction/complications ; Myocardial Infarction/mortality ; Myocardium/metabolism ; Retrospective Studies ; Treatment Outcome
Chemical Substances	ADIPOQ protein, human ; Adiponectin
Language	English
Publishing date	2015-07-20
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2250793-0
ISSN	1752-8984 ; 1479-1641
ISSN (online)	1752-8984
ISSN	1479-1641
DOI	10.1177/1479164115592638
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Article: A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study

Ray, Madhab / Ruthazer, Robin / Beshansky, Joni R / Kent, David M / Mukherjee, Jayanta T / Alkofide, Hadeel / Selker, Harry P

International journal of cardiology. Heart & vasculature

2015 Volume 9, Page(s) 37–42

Abstract: Background: The IMMEDIATE Trial of emergency medical service use of intravenous glucose-insulin-potassium (GIK) very early in acute coronary syndromes (ACS) showed benefit for the composite outcome of cardiac arrest or in-hospital mortality.: ... ...

Abstract	Background: The IMMEDIATE Trial of emergency medical service use of intravenous glucose-insulin-potassium (GIK) very early in acute coronary syndromes (ACS) showed benefit for the composite outcome of cardiac arrest or in-hospital mortality. Objectives: This analysis of IMMEDIATE Trial data sought to develop a predictive model to help clinicians identify patients at highest risk for this outcome and most likely to benefit from GIK. Methods: Multivariable logistic regression was used to develop a predictive model for the composite endpoint cardiac arrest or in-hospital mortality using the 460 participants in the placebo arm of the IMMEDIATE Trial. Results: The final model had four variables: advanced age, low systolic blood pressure, ST elevation in the presenting electrocardiogram, and duration of time since ischemic symptom onset. Predictive performance was good, with a C statistic of 0.75, as was its calibration. Stratifying patients into three risk categories based on the model's predictions, there was an absolute risk reduction of 8.6% with GIK in the high-risk tertile, corresponding to 12 patients needed to treat to prevent one bad outcome. The corresponding values for the low-risk tertile were 0.8% and 125, respectively. Conclusions: The multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.
Language	English
Publishing date	2015-08-27
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	2818464-6
ISSN	2352-9067
ISSN	2352-9067
DOI	10.1016/j.ijcha.2015.07.001
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Article ; Online: C-Reactive protein reactions to glucose-insulin-potassium infusion and relations to infarct size in patients with acute coronary syndromes.

Alkofide, Hadeel / Huggins, Gordon S / Beshansky, Joni R / Ruthazer, Robin / Peter, Inga / Ray, Madhab / Mukherjee, Jayanta T / Selker, Harry P

BMC cardiovascular disorders

2015 Volume 15, Page(s) 163

Abstract: Background: Some benefits of glucose-insulin-potassium (GIK) in patients with acute coronary syndromes (ACS) may be from an anti-inflammatory effect. The primary aim of this study was to assess the impact of GIK administration early in the course of ACS ...

Abstract	Background: Some benefits of glucose-insulin-potassium (GIK) in patients with acute coronary syndromes (ACS) may be from an anti-inflammatory effect. The primary aim of this study was to assess the impact of GIK administration early in the course of ACS on inflammatory marker C-reactive protein (CRP) levels. A secondary aim was to investigate the association between CRP and 30-day infarct size. Methods and results: Retrospective analysis of participants with ACS randomly assigned to GIK or placebo for at least 8 h in the IMMEDIATE Trial biological mechanism cohort (n = 143). High sensitivity CRP (hs-CRP) was measured at emergency department presentation, and 6 and 12 h into infusion. Logarithmically transformed hs-CRP values at 12-hours were lower with GIK vs. placebo (mean =0.65 mg/L in GIK, 0.84 mg/L in placebo), with a marginal trend toward significance (P = 0.053). Furthermore, using mixed models of hs-CRP, time, and study group, there was a significant increase in hs-CRP levels over time, but the rate of change did not differ between treatment arms (P = 0.3). Multivariable analysis showed that an elevation in hs-CRP, measured at 12 h, was an independent predictor of 30-day infarct size (β coefficient, 6.80; P = 0.04) using sestamibi SPECT imaging. Conclusions: The results of this study show no significant effect of GIK on hs-CRP. In addition our results show that in patients with ACS, hs-CRP measured as early as 12 h can predict 30-day infarct size.
MeSH term(s)	Acute Coronary Syndrome/blood ; Acute Coronary Syndrome/drug therapy ; Aged ; Biomarkers/blood ; C-Reactive Protein/metabolism ; Cardioplegic Solutions/administration & dosage ; Double-Blind Method ; Female ; Glucose/administration & dosage ; Humans ; Infusions, Intravenous ; Insulin/administration & dosage ; Male ; Middle Aged ; Myocardial Infarction/blood ; Myocardial Infarction/drug therapy ; Potassium/administration & dosage ; Retrospective Studies ; Time Factors
Chemical Substances	Biomarkers ; Cardioplegic Solutions ; Insulin ; glucose-insulin-potassium cardioplegic solution ; C-Reactive Protein (9007-41-4) ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2015-12-03
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/s12872-015-0153-7
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Article ; Online: Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study.

Sullivan, Alison L / Beshansky, Joni R / Ruthazer, Robin / Murman, David H / Mader, Timothy J / Selker, Harry P

Circulation. Cardiovascular quality and outcomes

2014 Volume 7, Issue 1, Page(s) 86–94

Abstract: Background: Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services care of ACS are poorly understood.: Methods and results: We performed an analysis of data from IMMEDIATE (Immediate Myocardial ... ...

Abstract	Background: Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services care of ACS are poorly understood. Methods and results: We performed an analysis of data from IMMEDIATE (Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care), a randomized controlled trial of emergency medical services treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital ECGs were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Women, participants with diabetes mellitus, and participants without previous cardiovascular disease waited longer to call 9-1-1 (by 28 minutes, P<0.01; 10 minutes, P=0.03; and 6 minutes, P=0.02, respectively), compared with their counterparts. Time from emergency medical services arrival to ECG was longer for women (1.5 minutes; P<0.01), older individuals (1.3 minutes; P<0.01), and those without a primary complaint of chest pain (3.5 minutes; P<0.01). On-scene times were longer for women (2 minutes; P<0.01) and older individuals (2 minutes; P<0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14, and 11 minutes, respectively; P<0.01). Women and older individuals had longer total times (medical contact to balloon inflation: 16 minutes, P=0.01, and 9 minutes, P<0.01, respectively; symptom onset to balloon inflation: 31.5 minutes for women; P=0.02). Conclusions: We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.
MeSH term(s)	Acute Coronary Syndrome/epidemiology ; Acute Coronary Syndrome/physiopathology ; Acute Coronary Syndrome/therapy ; Age Factors ; Aged ; Aged, 80 and over ; Chest Pain/epidemiology ; Cohort Studies ; Comorbidity ; Diabetes Mellitus/epidemiology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Regression Analysis ; Retrospective Studies ; Sex Factors ; Time Factors ; Time-to-Treatment/trends
Language	English
Publishing date	2014-01-14
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2483197-9
ISSN	1941-7705 ; 1941-7713
ISSN (online)	1941-7705
ISSN	1941-7713
DOI	10.1161/CIRCOUTCOMES.113.000396
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Article ; Online: A community consultation survey to evaluate support for and success of the IMMEDIATE trial.

Beshansky, Joni R / Sheehan, Patricia R / Klima, Kenneth J / Hadar, Nira / Vickery, Ellen M / Selker, Harry P

Clinical trials (London, England)

2014 Volume 11, Issue 2, Page(s) 178–186

Abstract: Background: The IMMEDIATE (Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care) Trial, a randomized controlled double-blind clinical effectiveness trial of glucose-insulin-potassium (GIK) administered in ... ...

Abstract	Background: The IMMEDIATE (Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care) Trial, a randomized controlled double-blind clinical effectiveness trial of glucose-insulin-potassium (GIK) administered in ambulances in the out-of-hospital setting, used the Exception from Informed Consent Requirements (EFIC) for Emergency Research under Title 21 of the Code of Federal Regulations. EFIC requirements include community consultation that typically involves using a variety of communication methods and venues to inform the public of the research and to receive their feedback. Although not the primary purpose of the community consultation process, a common concern to research sponsors, staff, and institutional review boards (IRBs) is whether there will be a sufficient number of participants to justify mounting a study in their community. Information from community consultation regarding the community acceptance might inform this question. Purpose: We evaluated the utility of telephone survey data done as part of the EFIC process as a way to project the ultimate rate of trial participant enrollment. Methods: A telephone survey community consultation process was undertaken in nine communities planning to be IMMEDIATE Trial sites using a representative sampling of the target population in the areas covered by participating emergency medical service (EMS) agencies. Survey respondents were read a description of the planned study and its informed consent approach that included the option for patients to decline participation in the trial while being transported for acute care in an ambulance. Survey respondents were then asked whether they would object to participating in the study. At the conclusion of actual trial enrollment, the Coordinating Center compared the survey results with the actual rates of enrollment at each site. Results: Approximately 200 (range = 200-271) respondents completed the survey in each of the study communities. Of 2079 survey respondents, 68% (range = 61%-75%) said that they would not object to participating in the trial if experiencing a heart attack, and 85% (range = 79%-89%) said that they would allow the study to be done in their community. During actual trial enrollment in the communities, 79% (range = 63%-91%) of the 828 potential participants agreed in the ambulance to have the study drug started and provided informed consent at the hospital, an average of 13 percentage-points higher than projected by the survey (95% confidence interval (CI): 9%-17%), 19% higher on a relative scale (CI: 14%-25%). Conclusions: The survey-based approach to community consultation proved to be an efficient way to obtain representative input from potential clinical trial participants. The survey data generated a relatively good and conservative estimate of the ultimate rate of trial enrollment. This information could be useful to investigators and IRBs in projecting enrollment for clinical trials using EFIC.
MeSH term(s)	Acute Coronary Syndrome/drug therapy ; Aged ; Community-Based Participatory Research/methods ; Data Collection ; Double-Blind Method ; Emergency Medical Services/methods ; Ethics Committees, Research ; Female ; Glucose/therapeutic use ; Humans ; Hypoglycemic Agents/therapeutic use ; Informed Consent ; Insulin/therapeutic use ; Male ; Middle Aged ; Multicenter Studies as Topic ; Potassium/therapeutic use ; Randomized Controlled Trials as Topic/methods
Chemical Substances	Hypoglycemic Agents ; Insulin ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2014-03-29
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2138796-5
ISSN	1740-7753 ; 1740-7745
ISSN (online)	1740-7753
ISSN	1740-7745
DOI	10.1177/1740774514526476
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Article ; Online: Glucose-insulin-potassium revived: current status in acute coronary syndromes and the energy-depleted heart.

Grossman, Alexandra N / Opie, Lionel H / Beshansky, Joni R / Ingwall, Joanne S / Rackley, Charles E / Selker, Harry P

Circulation

2013 Volume 127, Issue 9, Page(s) 1040–1048

MeSH term(s)	Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/metabolism ; Animals ; Cardioplegic Solutions/metabolism ; Cardioplegic Solutions/therapeutic use ; Glucose/metabolism ; Glucose/therapeutic use ; Humans ; Insulin/metabolism ; Insulin/therapeutic use ; Metabolic Networks and Pathways/physiology ; Myocardium/metabolism ; Potassium/metabolism ; Potassium/therapeutic use
Chemical Substances	Cardioplegic Solutions ; Insulin ; glucose-insulin-potassium cardioplegic solution ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2013-03-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.112.130625
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Article ; Online: In-hospital measurement of left ventricular ejection fraction and one-year outcomes in acute coronary syndromes: results from the IMMEDIATE Trial.

Mukherjee, Jayanta T / Beshansky, Joni R / Ruthazer, Robin / Alkofide, Hadeel / Ray, Madhab / Kent, David / Manning, Warren J / Huggins, Gordon S / Selker, Harry P

Cardiovascular ultrasound

2016 Volume 14, Issue 1, Page(s) 29

Abstract: Background: In patients with acute coronary syndrome (ACS), reduced left ventricular ejection fraction (LVEF) is a known marker for increased mortality. However, the relationship between LVEF measured during index ACS hospitalization and mortality and ... ...

Abstract	Background: In patients with acute coronary syndrome (ACS), reduced left ventricular ejection fraction (LVEF) is a known marker for increased mortality. However, the relationship between LVEF measured during index ACS hospitalization and mortality and heart failure (HF) within 1 year are less well-defined. Methods: We performed a retrospective analysis of 445 participants in the IMMEDIATE Trial who had LVEF measured by left ventriculography or echocardiogram during hospitalization. Results: Adjusting for age and coronary artery disease (CAD) history, lower LVEF was significantly associated with 1-year mortality or hospitalization for HF. For every 5 % LVEF reduction, the hazard ratio [HR] was 1.26 (95 % CI 1.15, 1.38, P < 0.001). Participants with LVEF < 40 % had higher hazard of 1-year mortality or HF hospitalization than those with LVEF > 40 (HR 3.59; 95 % CI 2.05, 6.27, P < 0.001). The HRs for the association of LVEF with the study outcomes were similar whether measured by left ventriculography or by echocardiography, (respectively, HR 1.32; 95 % CI 1.15, 1.51 and 1.21; 95 % CI 1.106, 1.35, interaction P = 0.32) and whether done within 24 h or not within 24 h (respectively, HR 1.28; 95 % CI 1.10, 1.50 and 1.23; 95 % CI 1.10, 1.38, interaction P = 0.67). Conclusions: Among patients with ACS, lower in-hospital LVEF is associated with increased 1-year mortality or hospitalization for HF, regardless of the method or timing of the LVEF assessment. This has prognostic implications for clinical practice and suggests the possibility of using various methods of LVEF determination in clinical research.
MeSH term(s)	Acute Coronary Syndrome/complications ; Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/physiopathology ; Aged ; Double-Blind Method ; Echocardiography/methods ; Female ; Follow-Up Studies ; Heart Failure/diagnosis ; Heart Failure/etiology ; Heart Failure/physiopathology ; Humans ; Inpatients ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stroke Volume/physiology ; Time Factors ; Ventricular Function, Left/physiology
Language	English
Publishing date	2016-08-03
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ISSN	1476-7120
ISSN (online)	1476-7120
DOI	10.1186/s12947-016-0068-1
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Article ; Online: Very early administration of glucose-insulin-potassium by emergency medical service for acute coronary syndromes: Biological mechanisms for benefit in the IMMEDIATE Trial.

Selker, Harry P / Harris, William S / Rackley, Charles E / Marsh, Julian B / Ruthazer, Robin / Beshansky, Joni R / Rashba, Eric J / Peter, Inga / Opie, Lionel H

American heart journal

2016 Volume 178, Page(s) 168–175

Abstract: Aims: In the IMMEDIATE Trial, intravenous glucose-insulin-potassium (GIK) was started as early as possible for patients with suspected acute coronary syndrome by ambulance paramedics in communities. In the IMMEDIATE Biological Mechanism Cohort substudy, ...

Abstract	Aims: In the IMMEDIATE Trial, intravenous glucose-insulin-potassium (GIK) was started as early as possible for patients with suspected acute coronary syndrome by ambulance paramedics in communities. In the IMMEDIATE Biological Mechanism Cohort substudy, reported here, we investigated potential modes of GIK action on specific circulating metabolic components. Specific attention was given to suppression of circulating oxygen-wasting free fatty acids (FFAs) that had been posed as part of the early GIK action related to averting cardiac arrest. Methods: We analyzed the changes in plasma levels of FFA, glucose, C-peptide, and the homeostasis model assessment (HOMA) index. Results: With GIK, there was rapid suppression of FFA levels with estimated levels for GIK and placebo groups after 2 hours of treatment of 480 and 781 μmol/L (P<.0001), even while patterns of FFA saturation remained unchanged. There were no significant changes in the HOMA index in the GIK or placebo groups (HOMA index: placebo 10.93, GIK 12.99; P = .07), suggesting that GIK infusions were not countered by insulin resistance. Also, neither placebo nor GIK altered endogenous insulin secretion as reflected by unchanging C-peptide levels. Conclusion: These mechanistic observations support the potential role of FFA suppression in very early cardioprotection by GIK. They also suggest that the IMMEDIATE Trial GIK formula is balanced with respect to its insulin and glucose composition, as it induced no endogenous insulin secretion.
MeSH term(s)	Acute Coronary Syndrome/blood ; Acute Coronary Syndrome/drug therapy ; Aged ; Angina Pectoris/blood ; Angina Pectoris/drug therapy ; Blood Glucose/metabolism ; C-Peptide/blood ; Early Medical Intervention ; Electrocardiography ; Emergency Medical Services/methods ; Fatty Acids, Nonesterified/blood ; Female ; Glucose/therapeutic use ; Heart Arrest/blood ; Heart Arrest/prevention & control ; Humans ; Hypoglycemic Agents/therapeutic use ; Infusions, Intravenous ; Insulin/therapeutic use ; Insulin Resistance ; Male ; Middle Aged ; Non-ST Elevated Myocardial Infarction/blood ; Non-ST Elevated Myocardial Infarction/drug therapy ; Potassium/therapeutic use ; ST Elevation Myocardial Infarction/blood ; ST Elevation Myocardial Infarction/drug therapy
Chemical Substances	Blood Glucose ; C-Peptide ; Fatty Acids, Nonesterified ; Hypoglycemic Agents ; Insulin ; Glucose (IY9XDZ35W2) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2016-06-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2016.03.026
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Article ; Online: Use of the electrocardiograph-based thrombolytic predictive instrument to assist thrombolytic and reperfusion therapy for acute myocardial infarction. A multicenter, randomized, controlled, clinical effectiveness trial.

Selker, Harry P / Beshansky, Joni R / Griffith, John L

Annals of internal medicine

2002 Volume 137, Issue 2, Page(s) 87–95

Abstract: Background: Deciding which patients should receive thrombolytic therapy or percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) can be difficult, especially for less-obvious candidates and when consulting ... ...

Abstract	Background: Deciding which patients should receive thrombolytic therapy or percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) can be difficult, especially for less-obvious candidates and when consulting physicians are off site. Objective: To test whether the electrocardiograph-based Thrombolytic Predictive Instrument (TPI) improves use of thrombolytic and overall reperfusion therapy. Design: 22-month randomized, controlled, clinical effectiveness trial. Setting: Emergency departments at 28 urban, suburban, and rural hospitals in the United States. Patients: Persons presenting to the emergency department with AMI and ST-segment elevation on an electrocardiogram (ECG). Intervention: TPI predictions automatically printed on ECG text headers. Measurements: Percentages of patients receiving thrombolytic therapy, thrombolytic therapy within 1 hour of initial ECG, and overall reperfusion (thrombolytic therapy or PTCA). Results: Of 2875 patients with AMI, 1243 (43.2%) had ST-segment elevation. Of these, 1197 were randomly assigned to study groups; 732 (61.2%) had inferior AMI, and 465 (38.8%) had anterior AMI. A total of 60.5% of controls and 62.1% of TPI patients (P = 0.2) received thrombolytic therapy, 52.5% of controls and 53.3% of TPI patients received thrombolytic therapy within 1 hour (P > 0.2), and 67.6% of controls and 70.3% of TPI patients received overall reperfusion (P = 0.2). Of patients with inferior AMI in the control group versus the TPI group, 61.1% versus 67.6% (P = 0.03) received thrombolytic therapy, 53.2% versus 58.6% (P = 0.08) received thrombolytic therapy within 1 hour, and 67.7% versus 74.7% (P = 0.03) received overall reperfusion. Of patients with anterior AMI in the control group versus the TPI group, 59.5% versus 53.9% (P > 0.2) received thrombolytic therapy, 51.4% versus 45.3% (P > 0.2) received thrombolytic therapy within 1 hour, and 67.6% versus 63.8% (P > 0.2) received overall reperfusion. Among women (n = 398) in the control group versus the TPI group, 48.1% versus 58.2% (P = 0.03) received thrombolytic therapy, 40.5% versus 48.4% (P = 0.10) received thrombolytic therapy within 1 hour, and 55.7% versus 65.7% (P = 0.04) received overall reperfusion. Of patients who required physician consultation by telephone (n = 271) in the control group versus the TPI group, 47.3% versus 63.2% (P = 0.01) received thrombolytic therapy, 41.1% versus 53.6% (P = 0.04) received thrombolytic therapy within 1 hour, and 50.7% versus 66.4% (P = 0.01) received overall reperfusion. Conclusions: The TPI increased use of thrombolytic therapy, use of thrombolytic therapy within 1 hour, and use of overall coronary reperfusion by 11% to 12% for patients with inferior AMI, 18% to 22% for women, and 30% to 34% for patients with an off-site physician. Although its effect was minimal on patients with high baseline reperfusion rates, the TPI increased use and timeliness of reperfusion in often-missed groups and when involved physicians were off site.
MeSH term(s)	Adult ; Angioplasty, Balloon, Coronary ; Decision Making, Computer-Assisted ; Electrocardiography/methods ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/therapy ; Thrombolytic Therapy ; United States
Language	English
Publishing date	2002-07-16
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/0003-4819-137-2-200207160-00006
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Article ; Online: Cocaine-using patients with a normal or nondiagnostic electrocardiogram: single-photon emission computed tomography myocardial perfusion imaging and outcome.

Hendel, Robert C / Ruthazer, Robin / Chaparro, Sandra / Martinez, Claudia / Selker, Harry P / Beshansky, Joni R / Udelson, James E

Clinical cardiology

2012 Volume 35, Issue 6, Page(s) 354–358

Abstract: Background: Few trials have examined the outcomes of patients who use cocaine with chest pain and who have a normal or nondiagnostic electrocardiogram (ECG) and the use of single-photon emission computed tomography (SPECT) myocardial perfusion imaging ( ... ...

Abstract	Background: Few trials have examined the outcomes of patients who use cocaine with chest pain and who have a normal or nondiagnostic electrocardiogram (ECG) and the use of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Hypothesis: We sought to compare the characteristics and overall outcomes in cocaine users vs non-cocaine users presenting to the emergency department with a normal/nondiagnostic ECG and to assess the value of rest MPI in both of these populations. Methods: Patients with symptoms compatible with myocardial ischemia, suspected acute coronary syndrome (ACS), and a normal/nondiagnostic ECG were enrolled in the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial, a randomized controlled trial designed to evaluate the impact of rest MPI on triage decisions. Cocaine users (n = 294) were compared to non-cocaine users (n = 2180). Cocaine users were younger than non-cocaine users, and 72% were male. Results: Among the cocaine users, 2.4% had a myocardial infarction, 1.4% required percutaneous coronary intervention, and none of the patients underwent coronary artery bypass graft surgery. Among cocaine users with a final diagnosis of not ACS, randomization of patients to rest SPECT MPI resulted in an appropriate reduction in hospital admissions in both the cocaine users (P = 0.011) and the non-cocaine users (P < 0.001), suggesting improved triage when MPI was used. Conclusions: Cocaine users with a normal/nondiagnostic ECG are at low risk of cardiac events. Even though cocaine users are at low risk of cardiac events, SPECT MPI remains effective in the risk stratification and improves triage management decisions resulting in lower admission rates and more discharges to home.
MeSH term(s)	Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/pathology ; Adult ; Chest Pain/diagnosis ; Chest Pain/etiology ; Chest Pain/pathology ; Chi-Square Distribution ; Cocaine/adverse effects ; Electrocardiography/instrumentation ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Myocardial Infarction/pathology ; Prospective Studies ; Risk Assessment ; Statistics as Topic ; Tomography, Emission-Computed, Single-Photon/instrumentation ; Treatment Outcome ; Triage
Chemical Substances	Cocaine (I5Y540LHVR)
Language	English
Publishing date	2012-02-23
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	391935-3
ISSN	1932-8737 ; 0160-9289
ISSN (online)	1932-8737
ISSN	0160-9289
DOI	10.1002/clc.21977
Database	MEDical Literature Analysis and Retrieval System OnLINE

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