改良HEART评分在急诊科胸痛患者中的预后评估效用
Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.
作者信息
McCord James, Cabrera Rafael, Lindahl Bertil, Giannitsis Evangelos, Evans Kaleigh, Nowak Richard, Frisoli Tiberio, Body Richard, Christ Michael, deFilippi Christopher R, Christenson Robert H, Jacobsen Gordon, Alquezar Aitor, Panteghini Mauro, Melki Dina, Plebani Mario, Verschuren Franck, French John, Bendig Garnet, Weiser Silvia, Mueller Christian
机构信息
From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2017 Feb;10(2). doi: 10.1161/CIRCOUTCOMES.116.003101.
BACKGROUND
The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.
METHODS AND RESULTS
Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).
CONCLUSIONS
Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
背景
TRAPID-AMI试验研究（用于急性心肌梗死快速排除的高敏肌钙蛋白T检测）在1小时急性心肌梗死（AMI）排除算法中评估了高敏心肌肌钙蛋白T（hs-cTnT）。我们的研究目的是评估改良HEART评分（m-HS）在该试验中的预后效用。
方法与结果
2011年至2013年，12个中心在急诊科对1282例可能患有AMI的患者进行了评估。在0、1、2以及4至14小时测量hs-cTnT（第99百分位数，14 ng/L）。对30天内的主要不良心脏事件（MACE，死亡或AMI）进行评估。低风险患者的m-HS≤3，且在系列检测中hs-cTnT<14 ng/L，或通过1小时方案排除AMI。通过1小时方案，777例（60%）患者的AMI被排除。在这777例患者中，515例（66.3%）患者的m-HS≤3，其中1例（0.2%）患者发生MACE；262例（33.7%）患者的m-HS≥4，其中6例（2.3%）患者发生MACE（P=0.007）。在4至14小时内，661例患者的hs-cTnT<14 ng/L。在这661例患者中，413例（62.5%）患者的m-HS≤3，其中1例（0.2%）患者发生MACE；248例（37.5%）患者的m-HS≥4，其中5例（2.0%）患者发生MACE（P=0.03）。
结论
1小时内对hs-cTnT进行系列检测并应用m-HS可识别出可能能够直接从急诊科出院的低风险人群。
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