Rational Pharmacotherapy in Cardiology

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The use of modern accelerated diagnostic protocols in patients with suspected acute coronary syndrome is discussed. Evidence base that can give occasion to selection of acceptable accelerated diagnostic protocol for safe exclusion of acute myocardial infarction early after seeking medical attention is presented. Advantages and disadvantages of certain protocols are discussed.

About the Authors

O. V. Baturina
N.V. Sklifosovsky Research Institute of Emergency Medicine
Russian Federation
Bolshaya Sukharevskaya pl. 3-7, Moscow, 7107045 Russia

S. R. Gilyarevsky
Russian Medical Academy of Postgraduate Education
Russian Federation
Barricadnaya ul. 2/1, Moscow, 123995 Russia


1. Pope J.H., Aufderheide T.P., Ruthazer R., et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342:1163-70.

2. Jernberg T., Lindahl B. A combination of troponin T and 12-lead electrocardiography: a valuable tool for early prediction of long-term mortality in patients with chest pain without ST-segment elevation. Am Heart J 2002;144:804-10.

3. Keller T., Zeller T., Peetz D., et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009;361:868-77.

4. Polanczyk C.A., Lee T.H., Cook E.F., et al. Cardiac troponin I as a predictor of major cardiac events in emergency department patients with acute chest pain. J Am Coll Cardiol 1998;32:8-14.

5. Cooper A., Calvert N., Skinner J., et al. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin. NICE clinical guidelines. Published March 2010. Accessed March 15, 2011.

6. Amsterdam E.A., Kirk J.D., Bluemke D.A., et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation 2010;122:1756-76.

7. Thygesen K., Alpert J.S., White H.D., et al. Universal definition of myocardial infarction. Circulation 2007;116:2634-53.

8. Anderson J.L., Adams C.D., Antman E.M., et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction. Circulation 2007;116:e148-e304.

9. Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010;31:2197-204.

10. Pollack C.V. Jr, Sites F.D., Shofer F.S., et al. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med 2006;13:13-8.

11. Diercks D.B., Peacock W.F. 4th, Hollander J.E., et al. Diagnostic accuracy of a point-of-care troponin I assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. Am Heart J 2012;163:74-80e4.

12. Hollander J.E. The continuing search to identify the very-low-risk chest pain patient. Acad Emerg Med 1999;6:979-81.

13. Corteville D.C., Armstrong D.F., Montgomery D.G., et al. Treatment and outcomes of first troponinnegative non-ST-segment elevation myocardial infarction. Am J Cardiol 2011;107:24-9.

14. Than M., Cullen L., Aldous S., et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012;59:2091-8.

15. Than M., Cullen L., Reid C.M., et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study. Lancet 2011;377:1077-84.

16. McCord J., Nowak R.M., McCullough P.A., et al. Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I. Circulation 2001;104:1483-88.

17. Body R., Carley S., McDowell G., et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 2011;58:1332-9.

18. Goodacre S.W., Bradburn M., Cross E., et al; RATPAC Research Team. The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of pointof-care cardiac markers in the emergency department. Heart 2011;97:190-6.

19. Aldous S.J., Richards M., CullenL, et al. A 2-hour Thrombolysis in Myocardial Infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: comparison of chest pain risk stratification tools. Am Heart J 2012;164:516-23.

20. Antman E.M., Cohen M., Bernink P.J., et al. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 2000;284:835-42.

21. Than M., Aldous S., Lord S.J., et al. A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial. JAMA Intern Med 2014;174:51-8.

22. Luepker R.V., Apple F.S., Christenson R.H., et al. Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute. Circulation 2003;108:2543-9.

23. Haltern G., Peiniger S., Bufe A., et al. Comparison of Usefulness of Heart-Type Fatty Acid Binding Protein Versus Cardiac Troponin T for Diagnosis of Acute Myocardial Infarction. Am J Cardiol 2010;105:1-9.

24. McMahon C.G., Lamont J.V., Curtin E., et al. Diagnostic accuracy of heart-type fatty acid-binding protein for the early diagnosis of acute myocardial infarction. Am J Emerg Med 2012;30:267-74.

25. Baturina OV, Gilyarevsky SR, Kuzmina IM, et al. Efficacy of combined use of tests for biomarkers for the diagnosis of myocardial infarction in the early period after the development of its clinical manifestations: the role of cardiac protein, fatty acid binding. Ration Pharmacother Cardiol 2012; 8 (3) :405-14. Russian (Батурина О.В., Гиляревский С.Р., Кузьмина И.М., и др. Эффективность сочетанно-го применения тестов на биомаркеры для диагностики инфаркта миокарда в ранние сроки после развития его клинических проявлений: роль кардиоспецифического белка, связывающего жир-ные кислоты. Рациональная Фармакотерапия в Кардиологии 2012;8(3):405-14).

26. Raskovalova T., Twerenbold R., O Collinson P., et al. Diagnostic accuracy of combined cardiac troponin and copeptin assessment for early rule-out of myocardial infarction: a systematic review and metaanalysis. European Heart Journal: Acute Cardiovascular Care 2014;3:18-27


For citations:

Baturina O.V., Gilyarevsky S.R. EFFICACY AND SAFETY OF ACCELERATED DIAGNOSTIC PROTOCOL USE IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME. Rational Pharmacotherapy in Cardiology. 2014;10(3):322-327. (In Russ.)

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