Crim Matthew T, Berkowitz Scott A, Saheed Mustapha, Miller Jason, Deutschendorf Amy, Gerstenblith Gary, Hill Peter, Korley Frederick K
From the *Department of Medicine, Emory University, Atlanta, GA; †Department of Medicine, ‡Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD; §Leadership, Johns Hopkins Medicine International, Baltimore, MD; ¶Leadership, Johns Hopkins Health System; and ‖Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI.
Crit Pathw Cardiol. 2016 Dec;15(4):138-144. doi: 10.1097/HPC.0000000000000091.
Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS).
We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital. The ED variables were assessed with logistic regression for their association with eventual ACS diagnosis at hospital discharge. ACS was diagnosed in 74 (26%) of the patients.
Non-ACS patients had a 2-day median length of stay and $6875 median inpatient (post ED) hospital charges (not including physician fees), totaling 566 hospital bed days and $1,871,250 for the 211 (74%) non-ACS patients. A novel risk score, including (1) history of prior revascularization, (2) comorbid chronic kidney disease, (3) onset of chest discomfort at rest, (4) dynamic electrocardiogram changes in the ED, (5) elevated troponin I (>0.05 ng/mL) in the ED, and (6) associated illness at presentation, discriminated ACS and non-ACS with a c statistic of 0.767; the c statistic for a modified thrombolysis in myocardial infarction risk score was 0.712.
Application of these risk scores may reduce the number of potentially avoidable admissions and their associated hazards and costs.
已知患有冠状动脉疾病且因胸痛前往急诊科（ED）就诊的患者常被收治入院，但可能并未发生急性冠状动脉综合征（ACS）。
我们评估了在急诊科获得的一种新型风险评分和改良的心肌梗死溶栓风险评分能否区分这些高危患者中哪些患有ACS。对一组285例已知患有冠状动脉疾病、因被认为是缺血性胸痛而前往急诊科就诊并入院的患者进行了病历审查。通过逻辑回归分析评估急诊科变量与出院时最终ACS诊断之间的关联。74例（26%）患者被诊断为ACS。
非ACS患者的中位住院时间为2天，住院期间（急诊科之后）的中位住院费用为6875美元（不包括医师费用），211例（74%）非ACS患者的总住院天数为566天，费用为1871250美元。一种新型风险评分，包括（1）既往血管重建史，（2）合并慢性肾病，（3）静息时胸痛发作，（4）急诊科动态心电图变化，（5）急诊科肌钙蛋白I升高（>0.05 ng/mL），以及（6）就诊时的相关疾病，区分ACS和非ACS的c统计量为0.767；改良的心肌梗死溶栓风险评分的c统计量为0.712。
应用这些风险评分可能会减少潜在可避免的入院人数及其相关风险和费用。
