Sudden death from acute thromboembolic occlusion of the left coronary ostium.

The patient was a 55-year-old woman who experienced anterior chest pain after drinking a cup of coffee. The patient had no risk factor for cardiac disease other than mild non- insulin-dependent diabetes mellitus. The patient did have a history of asthma and was on a steroid taper, taking 20 mg of prednisone daily.

One-year outcomes following coronary computerized tomographic angiography for evaluation of emergency department patients with potential acute coronary syndrome.

Objectives: Coronary computerized tomographic angiography (CTA) has high correlation with cardiac catheterization and has been shown to be safe and cost-effective when used for rapid evaluation of low-risk chest pain patients from the emergency department (ED). The long-term outcome of patients discharged from the ED with negative coronary CTA has not been well studied.

Methods: The authors prospectively evaluated consecutive low- to intermediate-risk patients who received coronary CTA in the ED for evaluation of a potential acute coronary syndrome (ACS).

Trends in boarding of admitted patients in US Emergency Departments 2003-2005.

Background: Boarding of admitted patients in the Emergency Department (ED) is common and is associated with poor patient outcomes.

Objectives: We sought to estimate the magnitude of and trends for ED boarding in the US.

Methods: We used the 2003-2005 National Hospital Ambulatory Medical Care Survey to estimate the time patients spent boarding in EDs in the US.

Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes.

Study Objective: Coronary computed tomographic (CT) angiography has excellent performance characteristics relative to coronary angiography and exercise or pharmacologic stress testing. We hypothesize that coronary CT angiography can identify a cohort of emergency department (ED) patients with a potential acute coronary syndrome who can be safely discharged with a less than 1% risk of 30-day cardiovascular death or nonfatal myocardial infarction.

Methods: We conducted a prospective cohort study at an urban university hospital ED that enrolled consecutive patients with potential acute coronary syndromes and a low TIMI risk score who presented to the ED with symptoms suggestive of a potential acute coronary syndrome and received a coronary CT angiography.

Actual financial comparison of four strategies to evaluate patients with potential acute coronary syndromes.

Objectives: Small studies have shown that a negative computed tomography coronary angiogram (CTA) in low-risk chest pain patients predicts a low rate of 30-day adverse events. The authors hypothesized that an immediate CTA strategy would be as effective but less costly than alternative strategies for evaluation of patients with potential acute coronary syndrome (ACS).

Methods: The authors retrospectively compared four strategies for evaluation of patients after initial physician determination that the patient required admission and testing to rule out ACS.