急诊科疑似急性冠脉综合征患者的HEART评分与TIMI风险评分比较

Comparison of the HEART and TIMI Risk Scores for Suspected Acute Coronary Syndrome in the Emergency Department.

作者信息

Sun Benjamin C, Laurie Amber, Fu Rongwei, Ferencik Maros, Shapiro Michael, Lindsell Christopher J, Diercks Deborah, Hoekstra James W, Hollander Judd E, Kirk J Douglas, Peacock W Frank, Anantharaman Venkataraman, Pollack Charles V

机构信息

From the *Department of Emergency Medicine, Oregon Health and Science University, Portland, OR; †Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR; ‡Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH; §Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX; ¶Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC; ‖Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA; **Department of Emergency Medicine, University of California Davis, Sacramento, CA; ††Department of Emergency Medicine, Baylor College of Medicine, Houston, TX; and ‡‡Department of Emergency Medicine, Singapore General Hospital, Singapore.

出版信息

Crit Pathw Cardiol. 2016 Mar;15(1):1-5. doi: 10.1097/HPC.0000000000000066.

DOI:10.1097/HPC.0000000000000066

PMID:26881812

Abstract

OBJECTIVES

The emergency department evaluation for suspected acute coronary syndrome (ACS) is common, costly, and challenging. Risk scores may help standardize clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TIMI) and HEART are two commonly cited risk scores. We tested the null hypothesis that the TIMI and HEART risk scores have equivalent test characteristics.

METHODS

We analyzed data from the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS) from 9 EDs on patients with suspected ACS, 1999-2001. We excluded patients with an emergency department diagnosis consistent with ACS, or without sufficient data to calculate TIMI and HEART scores. The primary outcome was 30-day major adverse cardiovascular events, including all-cause death, acute myocardial infarction, and urgent revascularization. We describe test characteristics of the TIMI and HEART risk scores.

RESULTS

The study cohort included 8255 patients with 508 (6.2%) 30-day major adverse cardiovascular events. Receiver operating curve and reclassification analyses favored HEART [c statistic: 0.753, 95% confidence interval (CI): 0.733-0.773; continuous net reclassification improvement: 0.608, 95% CI: 0.527-0.689] over TIMI (c statistic: 0.678, 95% CI: 0.655-0.702). A HEART score 0-3 [negative predictive value (NPV) 0.982, 95% CI: 0.978-0.986; positive predictive value (PPV) 0.103, 95% CI: 0.094-0.113; likelihood ratio (LR) positive 1.76; LR negative 0.28] demonstrates similar or superior NPV/PPV/LR compared with TIMI = 0 (NPV 0.978, 95% CI: 0.971-0.983; PPV 0.077, 95% CI: 0.071-0.084; LR positive 1.28; LR negative 0.35) and TIMI = 0-1 (NPV 0.963, 95% CI: 0.958-0.968; PPV 0.102, 95% CI: 0.092-0.113; LR positive 1.73; LR negative 0.58).

CONCLUSIONS

The HEART score has better discrimination than TIMI and outperforms TIMI within previously published "low-risk" categories.

摘要

目的

对疑似急性冠状动脉综合征（ACS）进行急诊科评估很常见、成本高昂且具有挑战性。风险评分可能有助于规范临床护理以及用于研究筛查。心肌梗死溶栓（TIMI）和HEART是两个经常被引用的风险评分。我们检验了TIMI和HEART风险评分具有等效检验特征的零假设。

方法

我们分析了1999 - 2001年来自9个急诊科的急性冠状动脉综合征互联网追踪注册研究（i*trACS）中疑似ACS患者的数据。我们排除了急诊科诊断符合ACS或没有足够数据来计算TIMI和HEART评分的患者。主要结局是30天主要不良心血管事件，包括全因死亡、急性心肌梗死和紧急血运重建。我们描述了TIMI和HEART风险评分的检验特征。

结果

研究队列包括8255例患者，其中508例（6.2%）发生了30天主要不良心血管事件。受试者工作特征曲线和重新分类分析显示，与TIMI（c统计量：0.678，95%置信区间（CI）：0.655 - 0.702）相比，HEART更具优势（c统计量：0.753，95% CI：0.733 - 0.773；连续净重新分类改善：0.608，95% CI：0.527 - 0.689）。HEART评分为0 - 3时[阴性预测值（NPV）0.982，95% CI：0.978 - 0.986；阳性预测值（PPV）0.103，95% CI：0.094 - 0.113；阳性似然比（LR）1.76；阴性LR 0.28]，与TIMI = 0（NPV 0.978，95% CI：0.971 - 0.983；PPV 0.077，95% CI：0.071 - 0.084；阳性LR 1.28；阴性LR 0.35）和TIMI = 0 - 1（NPV 0.963，95% CI：0.958 - 0.968；PPV 0.102，95% CI：0.092 - 0.113；阳性LR 1.73；阴性LR 0.58）相比，显示出相似或更优的NPV/PPV/LR。