Than Martin P, Pickering John W, Aldous Sally J, Cullen Louise, Frampton Christopher M A, Peacock W Frank, Jaffe Allan S, Goodacre Steve W, Richards A Mark, Ardagh Michael W, Deely Joanne M, Florkowski Chris M, George Peter, Hamilton Gregory J, Jardine David L, Troughton Richard W, van Wyk Pieter, Young Joanna M, Bannister Laura, Lord Sally J
Christchurch Hospital, Christchurch, New Zealand.
Christchurch Hospital, Christchurch, New Zealand; University of Otago, Christchurch, New Zealand.
Ann Emerg Med. 2016 Jul;68(1):93-102.e1. doi: 10.1016/j.annemergmed.2016.01.001.
A 2-hour accelerated diagnostic pathway based on the Thrombolysis in Myocardial Infarction score, ECG, and troponin measures (ADAPT-ADP) increased early discharge of patients with suspected acute myocardial infarction presenting to the emergency department compared with standard care (from 11% to 19.3%). Observational studies suggest that an accelerated diagnostic pathway using the Emergency Department Assessment of Chest Pain Score (EDACS-ADP) may further increase this proportion. This trial tests for the existence and size of any beneficial effect of using the EDACS-ADP in routine clinical care.
This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days.
Five hundred fifty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1% more patients (95% confidence interval 2.8% to 19.4%) were identified as low risk in EDACS-ADP (41.6%) than in ADAPT-ADP (30.5%). No low-risk patients had a major adverse cardiac event within 30 days (0.0% [0.0% to 1.9%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3%; ADAPT-ADP 34.4%; difference -2.1% [-10.3% to 6.0%], P=.65).
There was no difference in the proportion of patients discharged early despite more patients being classified as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates.
与标准治疗相比，基于心肌梗死溶栓评分、心电图和肌钙蛋白检测的2小时加速诊断路径（ADAPT-ADP）可提高急诊科疑似急性心肌梗死患者的早期出院率（从11%提高到19.3%）。观察性研究表明，使用胸痛急诊科评估评分（EDACS-ADP）的加速诊断路径可能会进一步提高这一比例。本试验旨在检测在常规临床护理中使用EDACS-ADP的任何有益效果的存在及大小。
这是一项针对疑似急性心肌梗死成人患者的实用随机对照试验，比较ADAPT-ADP和EDACS-ADP。主要结局是就诊后6小时内出院且30天内无后续重大不良心脏事件的患者比例。
共招募558例患者，每组279例。66例患者（11.8%）在30天内发生重大不良心脏事件（ADAPT-ADP组29例；EDACS-ADP组37例）；与ADAPT-ADP组（30.5%）相比，EDACS-ADP组（41.6%）中被确定为低风险的患者多11.1%（95%置信区间为2.8%至19.4%）。30天内无低风险患者发生重大不良心脏事件（0.0%[0.0%至1.9%]）。6小时内出院比例这一主要结局无差异（EDACS-ADP组32.3%；ADAPT-ADP组34.4%；差异为-2.1%[-10.3%至6.0%]，P = 0.65）。
尽管EDACS-ADP比ADAPT-ADP将更多患者分类为低风险，但早期出院患者比例并无差异。两种加速诊断路径都是胸痛评估的有效策略，与先前报道的比率相比，早期出院率有所提高。
