胸痛风险评分可降低急诊科观察病房中严重不良心脏事件发生率较低时的紧急心脏成像检查需求。

Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.

作者信息

Wang Hao, Watson Katherine, Robinson Richard D, Domanski Kristina H, Umejiego Johnbosco, Hamblin Layton, Overstreet Sterling E, Akin Amanda M, Hoang Steven, Shrivastav Meena, Collyer Michael, Krech Ryan N, Schrader Chet D, Zenarosa Nestor R

机构信息

From the *Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX; †Department of Emergency Medicine, Parkland Health and Hospital System, Dallas, TX; ‡Division of Emergency and Disaster Global Health, Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, TX; §Department of Emergency Medicine, Texas Health Huguley Hospital, Burleson, TX; ¶Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, TX; and ‖Research Institute, John Peter Smith Health Network, Fort Worth, TX.

出版信息

Crit Pathw Cardiol. 2016 Dec;15(4):145-151. doi: 10.1097/HPC.0000000000000090.

DOI:10.1097/HPC.0000000000000090

PMID:27846006

Abstract

OBJECTIVE

To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography.

METHODS

A prospective observational single center study was conducted from January 2014 through June 2015. EDOU chest pain patients were included. HEART, GRACE, and TIMI scores were categorized as low (HEART ≤ 3, GRACE ≤ 108, and TIMI ≤1) versus elevated based on thresholds suggested in prior studies. Patients were followed for 6 months postdischarge. The results of emergent cardiac imaging tests, EDOU length of stay (LOS), and MACE occurrences were compared. Student t test was used to compare groups with continuous data, and χ testing was used for categorical data analysis.

RESULTS

Of 986 patients, emergent cardiac imaging tests were performed on 62%. A majority of patients were scored as low risk by all tools (85% by HEART, 81% by GRACE, and 80% by TIMI, P < 0.05). The low-risk patients had few abnormal cardiac imaging test results as compared with patients scored as intermediate to high risk (1% vs. 11% in HEART, 1% vs. 9% in TIMI, and 2% vs. 4% in GRACE, P < 0.05). The average LOS was 33 hours for patients with emergent cardiac imaging tests performed and 25 hours for patients without (P < 0.05). MACE occurrence rate demonstrated no significant difference regardless of whether tests were performed emergently (0.31% vs. 0.97% in HEART, 0.27% vs. 0.95% in TIMI, and 0% vs. 0.81% in GRACE, P > 0.05).

CONCLUSIONS

Chest pain risk stratification via clinical decision tool scores can minimize the need for emergent cardiac imaging tests with less than 1% MACE occurrence, especially when the HEART score is used.

摘要

目的

比较和评估HEART评分、全球急性冠状动脉事件注册研究（GRACE）评分和心肌梗死溶栓（TIMI）评分在预测急诊科观察单元（EDOU）首次就诊后主要不良心脏事件（MACE）发生率方面的表现，并确定观察单元启动紧急心脏成像检查（即无创心脏负荷试验和有创冠状动脉造影）的必要性。

方法

2014年1月至2015年6月进行了一项前瞻性单中心观察性研究。纳入EDOU胸痛患者。根据既往研究建议的阈值，将HEART、GRACE和TIMI评分分为低（HEART≤3、GRACE≤108、TIMI≤1）与高。患者出院后随访6个月。比较紧急心脏成像检查结果、EDOU住院时间（LOS）和MACE发生情况。采用Student t检验比较连续数据组，χ检验用于分类数据分析。

结果

986例患者中，62%进行了紧急心脏成像检查。大多数患者被所有工具评为低风险（HEART评分为85%、GRACE评分为81%、TIMI评分为80%，P<0.05）。与中高风险评分患者相比，低风险患者的心脏成像检查异常结果较少（HEART评分中分别为1%对11%、TIMI评分中为1%对9%、GRACE评分中为2%对4%，P<0.05）。进行紧急心脏成像检查的患者平均LOS为33小时，未进行检查的患者为25小时（P<0.05）。无论是否进行紧急检查，MACE发生率均无显著差异（HEART评分中分别为0.31%对0.97%、TIMI评分中为0.27%对0.95%、GRACE评分中为0%对0.81%，P>0.05）。