Ely Sora, Chandra Abhinav, Mani Giselle, Drake Weiying, Freeman Debbie, Limkakeng Alexander T
Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
J Emerg Med. 2013 Feb;44(2):306-12. doi: 10.1016/j.jemermed.2012.07.048. Epub 2012 Sep 10.
Determining which patients presenting to the Emergency Department (ED) require further work-up for acute coronary syndrome (ACS) can be difficult. The utility of routine observation for cardiac testing in low-risk young adult patients has been questioned.
We investigated the rate of positive findings yielded by routine cardiac observation unit work-up in patients aged 40 years or younger.
This was a retrospective observational cohort study of patients aged 18-40 years who were evaluated for ACS in an ED-based observation unit. Data were collected by trained abstractors from electronic medical records.
A total of 362 patients met inclusion criteria. Of those, 239 received stress testing, yielding five positive and nine indeterminate results. One other patient had acute troponin elevation while under observation. The positive stress test patients and troponin-elevated patient underwent cardiac angiography. Only one positive stress test patient showed significant coronary stenosis and received coronary interventions. In follow-up data, one patient had an adverse cardiac outcome within 1 year of index visit, but no coronary interventions. Thus, only 3 patients had adverse cardiac events, with only one patient warranting intervention discovered by observation unit stress testing and a second via serial cardiac markers.
Routine observation of symptomatic young adults for ACS had low yield. Observation identified one patient with acute cardiac marker elevation and further stress testing identified only one patient with intervenable ACS, despite a high false-positive rate. This suggests that observation and stress testing should not be routinely performed in this demographic absent other high-risk features.
确定哪些到急诊科（ED）就诊的患者需要进一步检查急性冠状动脉综合征（ACS）可能具有挑战性。对于低风险的年轻成年患者进行心脏检查的常规观察的效用受到了质疑。
我们调查了40岁及以下患者在常规心脏观察病房检查中获得阳性结果的比例。
这是一项对在基于急诊科的观察病房接受ACS评估的18 - 40岁患者的回顾性观察队列研究。数据由经过培训的提取人员从电子病历中收集。
共有362名患者符合纳入标准。其中，239名接受了负荷试验，产生了5个阳性和9个不确定结果。另有一名患者在观察期间肌钙蛋白急性升高。负荷试验阳性的患者和肌钙蛋白升高的患者接受了心脏血管造影。只有一名负荷试验阳性患者显示出明显的冠状动脉狭窄并接受了冠状动脉介入治疗。在随访数据中，一名患者在首次就诊后1年内出现不良心脏结局，但未进行冠状动脉介入治疗。因此，只有3名患者发生了不良心脏事件，观察病房负荷试验仅发现一名需要干预的患者，另一名是通过连续心脏标志物发现的。
对有症状的年轻成年人进行ACS的常规观察阳性率较低。观察发现一名患者心脏标志物急性升高，进一步的负荷试验仅发现一名可进行干预的ACS患者，尽管假阳性率较高。这表明在没有其他高风险特征的情况下，不应在这一人群中常规进行观察和负荷试验。
