Abstract:
OBJECTIVE:We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission. METHODS:We prospectively collected data on 400 patients admitted through our emergency room for unstable angina and acute coronary syndromes. Patients with ST-segment elevation myocardial infarction and those who required thrombolysis were excluded. RESULTS:Of 383 patients who were eligible, 120 patients had coronary events within 30 days. Statistically significant variables associated with coronary events were advanced age, male sex, family history of premature coronary artery disease (CAD), diabetes mellitus, tobacco abuse, prior congestive heart failure, prior myocardial infarction, and history of CAD. Symptoms at presentation associated with cardiac events were typical angina and shortness of breath. Objective measures of ischemia associated with cardiac events were elevated troponin T, elevated creatine kinase MB, and ischemic electrocardiographic changes. Using forward stepwise regression analysis, we generated a model to predict 30-day major adverse cardiac events. The strongest predicting variable was serum troponin T (accounting for 33% of predicting r2, P < 0.001) followed by typical angina (r2 increasing to 37%), ischemic electrocardiographic changes (40%), prior CAD (42%), family history of premature CAD (44%), shortness of breath (46%), and positive creatine kinase MB (48%). The positive predictive power of the complete model was r2 = 48%, P < 0.001. CONCLUSION:Our model incorporating elements from the patient's demographic, medical history, presentation, and ischemic assessment identified 48% of patients presenting with unstable angina and acute coronary syndromes who will suffer a major adverse cardiac event within 30 days of admission. Although the strongest predictor was identified as serum troponin T, other clinical criteria offered improvement in our predictive abilities. Therefore, good initial clinical evaluation in addition to simple tests such as serum cardiac markers and electrocardiography are valuable in risk stratification of patients presenting with acute coronary syndromes and cardiac chest pain. Additional testing may be necessary to improve the positive predictive value of the model. Cardiac enzymes and electrocardiographic changes have the highest negative predictive value for occurrence of major adverse cardiac events. Identification of high-risk patients is essential to direct resources toward these patients and to avoid unnecessary costs and risk to the low-risk population.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Tadros GM,McConnell TR,Wood GC,Costello JM,Iliadis EAdoi
10.1097/01.SMJ.0000053481.49309.58subject
Has Abstractpub_date
2003-11-01 00:00:00pages
1113-20issue
11eissn
0038-4348issn
1541-8243journal_volume
96pub_type
杂志文章abstract:OBJECTIVES:A retrospective cross-sectional study was performed to assess the prevalence of elevated alkaline phosphatase (ALP) in patients infected with human immunodeficiency virus (HIV) and to determine the relation between ALP and specific antiretroviral therapy (ART). METHODS:A total of 2990 patients were included...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000500
更新日期:2016-08-01 00:00:00
abstract::In the past 30 years there has been no improvement in the five-year survival rate for endometrial carcinoma. Any change comparable to improved survival in cervical carcinoma will be accomplished only by similar detection of the early asymptomatic and precursor lesions of endometrial carcinoma. Reasons why the conventi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198004000-00022
更新日期:1980-04-01 00:00:00
abstract::We have reported a case of severe erythema multiforme caused by outbreaks of recurrent HSV-2 infection. The EM was debilitating and responded to the treatment of HSV with oral acyclovir. On stopping the oral acyclovir, the HSV and the EM both recurred. We recommend a trial of oral acyclovir in cases of severe EM cause...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198606000-00027
更新日期:1986-06-01 00:00:00
abstract::This review article provides insight into the evolution of professional healthcare chaplaincy. It identifies key historical developments identifying the training, qualifications, and competencies of chaplains. Consideration is given to both the unique character of the pastoral role in healthcare as well as the contrib...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.smj.0000220893.37354.1e
更新日期:2006-06-01 00:00:00
abstract::The demented patient requires medical and often psychiatric supervision, but the caregiver is often neglected. This article identifies special issues for caregivers that may need attention from the demented patient's physician. The physician's attention can benefit both the patient and the caregiver and save the physi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract::This case presents a rare type of crescentic glomerulonephritis characterized as IgA deposits predominantly along the glomerular basement membranes (GBM). The patient clinically manifested with rapidly progressive glomerulonephritis (RPGN) without pulmonary hemorrhage or vasculitis-related systematic symptoms. No posi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181817c22
更新日期:2008-09-01 00:00:00
abstract::An unusual volar and radial perilunate transscaphoid fracture dislocation is reported. Treatment of perilunate transscaphoid fracture dislocations by closed reduction often produces a poor result. Early open reduction may be followed by a good result, but if open reduction is impossible, proximal row carpectomy is adv...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197507000-00025
更新日期:1975-07-01 00:00:00
abstract::We present the first two known cases of infantile botulism in Oklahoma. The first case was due to type B toxin; the second was due to type A toxin. Both cases demonstrate most of the classic features of what now appears to be the most common form of botulism. Infantile botulism is an underrecognized but reversible cau...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198804000-00012
更新日期:1988-04-01 00:00:00
abstract::Serologic tests for the diagnosis of blastomycosis have had inadequate sensitivity, but results are improved with enzyme immunoassay (EIA) with A-antigen of Blastomyces dermatitidis. The Premier Blastomyces EIA kit (Meridian Diagnostics Inc, Cincinnati, Ohio) detected antibody against the B dermatitidis A-antigen in s...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199512000-00013
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:To determine the prevalence of overweight in a cardiac stress testing population, and the percentage of subjects who indicate a history of overweight. METHODS:A total of 251 consecutive subjects presenting for cardiac stress testing in a 450-bed community hospital from June to September 2010 were asked to c...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e31821e9359
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Non-insulin-dependent diabetes mellitus (NIDDM) and hyperhomocysteinemia are both associated with increased lipid peroxidation (oxidative stress). This may contribute to the accelerated vascular disease associated with these conditions. It is not known whether the coexistence of elevated homocysteine levels ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199709000-00008
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Conventional magnetic resonance imaging (MRI) of complex cervical spine disorders may underestimate the magnitude of structural disease because imaging is performed in a nondynamic non-weight-bearing manner. Myelography provides additional information but requires an invasive procedure. METHODS:This was a p...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章
doi:10.1097/00007611-200405000-00008
更新日期:2004-05-01 00:00:00
abstract::In this study, the pelvic retroperitoneal anatomy was dissected during 140 consecutive exploratory laparotomies for benign gynecologic disease. In addition, 110 bilateral hypogastric artery ligations were done both to teach the technique and to attempt to determine whether such a procedure reduces blood loss in electi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198703000-00005
更新日期:1987-03-01 00:00:00
abstract::Herpes zoster and disseminated herpes zoster, or varicella (V-Z), continue to be dreaded complications of patients with immunosuppression. Currently, there is no available therapy for V-Z, except for general supportive measures. Seven cases of V-Z are presented, showing the results of cytosine arabinoside administrati...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197808000-00011
更新日期:1978-08-01 00:00:00
abstract::We describe two cases of drug-induced hypertriglyceridemia, one associated with interferon alfa-2b and the other with asparaginase, each of which is mediated through a different mechanism. Hypertriglyceridemia caused by these medications is not listed as an adverse reaction in the Physicians' Desk Reference, one of th...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199909000-00013
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:The management of acute pain is an aspect of hospital-based practice that has been neglected. Control of pain is important for ethical reasons, for compliance with new guidelines and standards, and for optimizing patient satisfaction and outcomes. METHODS:Be review the rationale for establishing priority to...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199905000-00003
更新日期:1999-05-01 00:00:00
abstract::We have described a patient with small cell cancer of the lung manifested as the Eaton-Lambert syndrome. Primary therapy proved effective in reversing the syndrome, whereas anticholinesterase agents did not. This case illustrates the value of primary therapy for the tumor-produced syndrome and the need to avoid losing...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198502000-00020
更新日期:1985-02-01 00:00:00
abstract::A case of Wuchereria bancrofti filariasis was recently seen in a Haitian immigrant in Charleston, SC. The Caribbean area is a known endemic focus for this organism. With the increased numbers of immigrants from that area, it is likely that other such cases will be seen in the US. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198504000-00032
更新日期:1985-04-01 00:00:00
abstract::Premalignant lesions of the anal margin include Bowen's disease (intraepithelial squamous cell carcinoma) and Paget's disease (intraepithelial adenocarcinoma). Our experience includes 11 patients with perianal Paget's disease and 37 patients with perianal Bowen's disease treated from 1957 to 1986. The patients with pe...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198904000-00016
更新日期:1989-04-01 00:00:00
abstract::A 63-year-old male patient with a history of bipolar I disorder presented to the emergency department in an acutely psychotic state. The patient had just returned from vacation in a malarial high-risk area and, as a result, had taken five weekly doses of mefloquine for prophylaxis. The patient's bipolar disorder was b...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e318167a9e2
更新日期:2008-05-01 00:00:00
abstract::An infected echinococcal cyst of the liver was diagnosed in a 48-year-old male immigrant from Spain. After preoperative treatment with mebendazole, microscopic examination of the operative cyst contents showed no viable scoleces or brood capsules of Echinococcus. We recommend the preoperative use of mebendazole in the...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Increasing numbers of the adult population are using alternative or complementary health resources in the treatment of chronic medical conditions. Systemic hypertension affects more than 50 million adults and is one of the most common risk factors for cardiovascular morbidity and mortality. This study evalua...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00007611-200111000-00015
更新日期:2001-11-01 00:00:00
abstract::The clinical presentations of liver abscess, hepatoma, and metastatic tumor to the liver may be quite similar, and procedures such as computerized tomography, radionuclide scanning, and ultrasonography of the liver cannot make a specific diagnosis. Therefore, we compared the clinical presentations of 38 patients seen ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198712000-00013
更新日期:1987-12-01 00:00:00
abstract::A 37-year-old black man with presumed Pneumocystis carinii pneumonia who was treated with systemic IV pentamidine had fatal pancreatitis and massive hepatomegaly. Fatal pancreatitis can occur with no hemorrhagic changes seen at autopsy. Awareness of the relationship between pentamidine and pancreatitis should be empha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1991-06-01 00:00:00
abstract::Nontyphoidal salmonellae (NTS) are often isolated from stool specimens of individuals having evaluation of gastroenteritis. The significance of isolation of NTS in a stool specimen from previously healthy individuals with gastroenteritis is not clear. The purpose of this study was to determine which serotypes were bei...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199508000-00009
更新日期:1995-08-01 00:00:00
abstract::Pregnancy in patients who have non-Hodgkin's lymphoma is unusual. We have reported a case of diffuse, poorly differentiated lymphocytic lymphoma, stage IIIa, in a patient whose disease went into remission after she received six courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone). She...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198510000-00032
更新日期:1985-10-01 00:00:00
abstract::We have reported a case of Campylobacter osteomyelitis, which we believe has not been previously reported. Symptoms and signs were nonspecific, but darkfield microscopy of a suspension of isolated bacteria was useful in making a presumptive diagnosis. Initial parenteral therapy based on sensitivity testing and prolong...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198412000-00044
更新日期:1984-12-01 00:00:00
abstract::A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature. The disease is characterized by an acute febrile illness with painful plaques involving the extremities, face, and neck, and ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197811000-00010
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:This study was performed to examine the effect of stress on pregnancy outcome in women who underwent assisted reproductive technology (ART) procedures. METHODS:In a controlled clinical study of healthy volunteers in an academic research environment, stress was measured subjectively by administering patient ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000054567.79881.E9
更新日期:2003-06-01 00:00:00
abstract::Carbon monoxide (CO) has been widely recognized as an exogenous poison, although endogenous mechanisms for its formation involve heme-oxygenase (HO) isoforms, more specifically HO-1, in the setting of oxidative stress such as acute respiratory distress syndrome, sepsis, trauma, and nitric oxide use have been studied. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181fd7f69
更新日期:2011-01-01 00:00:00