Leung Yuk-Ki, Cheng Nga-Man, Chan Cangel Pui-Yee, Lee Anna, Wong Jeffrey Ka-Tak, Yan Bryan Ping-Yen, Ahuja Anil Tejbhan, Graham Colin Alexander, Rainer Timothy Hudson
Accident and Emergency Medicine Academic Unit, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong.
J Emerg Med. 2017 Sep;53(3):287-294. doi: 10.1016/j.jemermed.2017.05.006.
The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin.
We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for early rule out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART (history, electrocardiogram, age, risk factors, troponin) score.
We recruited 602 consecutive adult patients with chest pain and suspected ACS in the ED. Each patient had TIMI and HEART scores, and a point-of-care H-FABP test.
MACE occurred in 42 (7.0%) patients within 30 days. A low risk for 30-day MACE was identified by a modified TIMI score of 0 in 65 (11%) patients, and by a HEART score ≤ 2 in 96 (16%) patients. No MACE occurred in these groups, giving both scores a sensitivity of 100% (95% confidence interval [CI] 91.6-100%), and specificity of 11.6% (95% CI 9.2-14.5%) and 17.1% (95% CI 14.2-20.5%), respectively. Use of combined TIMI and HEART scores improved the specificity further to 22.0% (95% CI 18.7-25.6%) without lowering sensitivity. Early H-FABP measurement > 7 μg/L had a sensitivity of 41.5% (95% CI 27.8-56.6%) and a specificity of 91.1% (95% CI 88.4-93.2%) for predicting 30-day MACE.
A modified TIMI score of 0 or a HEART score of ≤ 2, incorporating a single hs-cTnT level, will identify patients with low risk of 30-day MACE for early discharge within 2 h of ED arrival.
目前对因疑似急性冠脉综合征（ACS）而到急诊科（ED）就诊的胸痛患者的评估是一个漫长的过程，包括对肌钙蛋白的系列检测。
我们旨在验证心肌梗死溶栓（TIMI）评分结合单次高敏心肌肌钙蛋白T（hs-cTnT）对30天主要不良心脏事件（MACE）早期排除的诊断准确性，并将TIMI评分与心脏型脂肪酸结合蛋白（H-FABP）及改良的HEART（病史、心电图、年龄、危险因素、肌钙蛋白）评分组合进行比较。
我们招募了602例连续的因胸痛且疑似ACS而到急诊科就诊的成年患者。每位患者均有TIMI和HEART评分，并进行了即时H-FABP检测。
42例（7.0%）患者在30天内发生了MACE。改良TIMI评分为0的65例（11%）患者及HEART评分≤2的96例（16%）患者被确定为30天MACE低风险。这些组中均未发生MACE，两种评分的敏感性均为100%（95%置信区间[CI] 91.6 - 100%），特异性分别为11.6%（95% CI 9.2 - 14.5%）和17.1%（95% CI 14.2 - 20.5%）。联合使用TIMI和HEART评分可将特异性进一步提高至22.0%（95% CI 18.7 - 25.6%）而不降低敏感性。早期H-FABP检测>7μg/L对预测30天MACE的敏感性为41.5%（95% CI 27.8 - 56.6%），特异性为91.1%（95% CI 88.4 - 93.2%）。
改良TIMI评分为0或HEART评分≤2（纳入单次hs-cTnT水平）可识别出30天MACE低风险患者，以便在到达急诊科后2小时内早期出院。
