This e-mail is to ensure that everyone is aware of the study starting this Monday, May 14 in the Emergency Department at Victoria Hospital.
This study is looking at the use of urgent CT coronary angiography and rest MIBI in the assessment of patients presenting with chest pain potentially related to an acute coronary syndrome. It is to enroll moderate-risk patients during weekdays, daytime hours (0600-1600h), with a goal of showing that it is practical and feasible to do these studies acutely on ED patients. These tests have been shown to be useful in the diagnosis of ACS, but their use in moderate risk ED patients is new.
This is a collaborative study with cardiology. Our role is to identify and refer potential participants for the study. I’m asking you to please look for the bright ORANGE coloured forms on all patients with chest pain, and fill out the one page screening form. If the patient seems to fit the study criteria, page the CCU resident to see the patient for possible enrollment.
Enrollment will happen after the first troponin is done, as it is one of the screening criteria. You will need to do two different scoring systems to stratify the patients. The first is the Braunwald criteria, which looks at factors on the history, physical, and labs to determine a risk category. (See table below, or in the attachment.) Then do the TIMI scoring. Use these two results in the table, and if they fall into the white zone and seem like a possible study candidate page CCU. If you can, please fill in the time you page CCU, and also the final line on the page; your opinion on whether or not the patient should be admitted (from the information you have at that time).CCU/cardiology is responsible for enrolling the patients, getting consent, and the disposition of the enrolled patients. If the patient doesn’t fall in the white zone, just leave the completed form on the chart and it will be collected.
Major exclusions are: CREATININE > 130, contrast allergy, inability to give consent (languary barrier or other), hemodynamic instability, ST segment MI, and need for urgent investigation for other significant cause of chest pain. (So, if you’re more worried about dissection or PE, do those tests without worrying about the study.) And if you are worried the patient seems too unstable to leave the ED (despite the scoring systems), then let the CCU resident know this, or don’t enroll them.
If you’re not sure and think the patient might qualify for the study, page CCU and they can clarify. Dr. Humen, the lead investigator for the study, is the CCU consultant on next week, so if we can get some patients referred for the study, would be great. It will give us the best opportunity to see what problems there might be.There will be patient information letters by the doctors desk in A pod and in B pod as well. If you have a chance, please give these to patients referred for the study to let them start reading it while waiting for the CCU resident to try to speed things up. If you don’t have time, don’t worry about it.
Please let me know if you have questions, or when any problems come up. This hasn’t been an easy study to get consensus on from the various people involved, but, I think it is interesting and potentially useful… so hopefully we can make it work.
Sorry about the length of the e-mail.
Again, PLEASE let me know your questions/concerns/problems you run into.