评估欧洲心脏病学会 0 小时/1 小时算法在排除和诊断急性心肌梗死中的作用。
Assessment of the European Society of Cardiology 0-Hour/1-Hour Algorithm to Rule-Out and Rule-In Acute Myocardial Infarction.
机构信息
From Emergency Department (J.W.P., M.P.T.), and Cardiology Department (S.A.), Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand (J.W.P.); Department of Emergency Medicine, Royal Brisbane and Women's Hospital, The University of Queensland and School of Public Health, Queensland University of Technology, Brisbane, Australia (J.H.G., L.C., D.F.); Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia (W.P.); Canterbury Health Laboratories, Christchurch, New Zealand (P.G.); and McMaster University, Hamilton, Ontario, Canada (A.W., P.A.K.).
出版信息
Circulation. 2016 Nov 15;134(20):1532-1541. doi: 10.1161/CIRCULATIONAHA.116.022677. Epub 2016 Oct 17.
BACKGROUND
The new European Society of Cardiology guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at 0 and 1 hour. Emergency department physicians require high sensitivity to confidently rule-out AMI, whereas cardiologists aim to minimize false-positive results.
METHODS
High-sensitivity troponin I and T assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia, and Canada. AMI outcomes were independently adjudicated by at least 2 physicians. The European Society of Cardiology algorithm performance with each assay was assessed by the sensitivity and proportion with AMI ruled out and the positive predictive value and proportion ruled-in.
RESULTS
There were 2222 patients with serial high-sensitivity troponin T and high-sensitivity troponin I measurements. The high-sensitivity troponin T algorithm ruled out 1425 (64.1%) with a sensitivity of 97.1% (95% confidence interval [CI], 94.0%-98.8%) and ruled-in 292 (13.1%) with a positive predictive value of 63.4% (95% CI, 57.5%-68.9%).The high-sensitivity troponin I algorithm ruled out 1205 (54.2%) with a sensitivity of 98.8% (95% CI, 96.4%-99.7%)) and ruled-in 310 (14.0%) with a positive predictive value of 68.1% (95% CI, 62.6%-73.2%).
CONCLUSIONS
The sensitivity of the European Society of Cardiology rapid assessment 0-/1-hour algorithm to rule-out AMI with high-sensitivity troponin may be insufficient for some emergency department physicians to confidently send patients home. These algorithms may prove useful to identify patients requiring expedited management. However, the positive predictive value was modest for both algorithms.
背景
欧洲心脏病学会新指南用于在急诊科诊断和排除急性心肌梗死（AMI），包括一种基于高敏心肌肌钙蛋白的快速评估算法，以及 0 小时和 1 小时的采样。急诊科医生需要高度敏感以有信心排除 AMI，而心脏病专家则旨在尽量减少假阳性结果。
方法
高敏肌钙蛋白 I 和 T 检测用于测量新西兰、澳大利亚和加拿大医院因胸痛症状就诊且疑似急性冠脉综合征患者的肌钙蛋白浓度。AMI 结局由至少 2 位医生独立裁决。通过排除 AMI 的患者比例和敏感度、纳入 AMI 的阳性预测值和患者比例评估每个检测方法的欧洲心脏病学会算法性能。
结果
共有 2222 例患者进行了连续的高敏肌钙蛋白 T 和高敏肌钙蛋白 I 测量。高敏肌钙蛋白 T 算法排除了 1425 例（64.1%），敏感度为 97.1%（95%可信区间[CI]：94.0%-98.8%），纳入了 292 例（13.1%），阳性预测值为 63.4%（95%CI：57.5%-68.9%）。高敏肌钙蛋白 I 算法排除了 1205 例（54.2%），敏感度为 98.8%（95%CI：96.4%-99.7%），纳入了 310 例（14.0%），阳性预测值为 68.1%（95%CI：62.6%-73.2%）。
结论
对于一些急诊科医生来说，使用高敏肌钙蛋白进行欧洲心脏病学会快速评估 0/1 小时算法来排除 AMI 的敏感度可能不足，无法有信心地让患者回家。这些算法可能有助于识别需要紧急治疗的患者。然而，两种算法的阳性预测值都较低。
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