Abstract 18043: Factors That Influence the Decision for Ischemic Work-up in Hypertensive Emergency
Background: Hypertensive emergencies (HE) account for 3% of emergency room hospitalizations and it is estimated that 1-2% of America’s 50 million hypertensive patients will have at least one occurrence of HE in their lifetime. Recent studies have shown that cardiac troponin-I is elevated in a third of patients with HE, however the pathophysiology and significance of this elevation is still being explored. We tried to look at different factors that influence the decision to do ischemic work up in patients with HE.
Method: Patients admitted to Albert Einstein Medical Center from 01/01/2005 to 08/30/2014 with a diagnosis of HE were included in this retrospective study. Patients were divided into two groups: those who had either cardiac catheterization or stress test, and those who had no ischemic work up. Demographic and clinical variables were collected. A cumulative risk score for coronary artery disease was calculated by assigning 1 point for each risk factor.
Results: There were total of 187 patients with HE of which only 37 had ischemic work up. 20 out of the 37 patients who had ischemic work up had chest pain. Of the 20 patients only 3 were found to have significant coronary artery disease. Comparisons between the demographics and clinical predictors in both groups are shown in the table. Multivariate analysis shows chest pain to independently predict which patients were more likely to receive an ischemic work up (OR=4.7; 95% CI 1.6 to 7.6; p=0.001).
Conclusion: In the setting of HE, our study shows that chest pain was the only single factor that independently predicts which HE patients are more likely to receive an ischemic work up. Elevated troponins or EKG changes alone were not found to independently predict the decision to perform an ischemic work up. This may reflect the pattern of clinical practice at our center. Large multi-center studies might be needed to explore this further and also assess the clinical outcomes of this decision making process.
Author Disclosures: O. Maludum: None. K. Mezue: None. S. Biso: None. M. Rodriguez-Ziccardi: None. T. Alnabelsi: None. M. Shah: None. C. Nwakile: None. V. Figueredo: None.
- © 2015 by American Heart Association, Inc.