Critical Pathways in Cardiology by Christopher P. Cannon (Editor), Patrick T. O'Gara (Editor)

By Christopher P. Cannon (Editor), Patrick T. O'Gara (Editor)

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Ann Emerg Med 1993;22:794–798. 65. Kirk JD, Turnipseed S, Lewis WR, et al. Evaluation of chest pain in low risk patients presenting to the emergency department: the role of immediate exercise testing. Ann Emerg Med 1998;32:1–7. 66. Lewis WR, Amsterdam EA. Utility and safety of immediate exercise testing of low risk patients admitted to the hospital for suspected acute myocardial infarction. Am J Cardiol 1994;74:987–990. 67. Stuart RJ, Ellestad MH. National survey of exercise stress testing facilities.

8-2). Of note, as had been observed in the National Registry of Myocardial Infarction (NRMI) (10), women have longer door-to-drug times, which did improve to an even greater extent after implementation of the pathway (Fig. 8-3) (9). Similarly, others have reported improvements in door-to-drug times with other types of critical pathways or “fast-track” algorithms for acute MI (Fig. 8-4) (11,12 and 13). Of note, evidence has recently been reported showing a direct relationship between longer door-to-drug times and increased mortality (Fig.

This classification was subsequently validated (70). Similar observations have been made in the Thrombolysis and Angioplasty in Acute Myocardial Infarction (TAMI) trials, in GUSTO-I, and, most recently, in the InTIME-II trial (Fig. 8-8) (67,71,72). FIG. 8-8. TIMI risk score for ST-segment elevation myocardial infarction. (Reproduced from Morrow DA, Antman EM, Charlesworth A, et al. The TIMI risk score for ST elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation.

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