Department of Acute & Tertiary Care Nursing, University of Pittsburgh, PA, United States; Department of Emergency Medicine, University of Pittsburgh, PA, United States.
Department of Acute & Tertiary Care Nursing, University of Pittsburgh, PA, United States; University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States.
Am J Emerg Med. 2019 Mar;37(3):461-467. doi: 10.1016/j.ajem.2018.06.020. Epub 2018 Jun 8.
Many of the clinical risk scores routinely used for chest pain assessment have not been validated in patients at high risk for acute coronary syndrome (ACS). We performed an independent comparison of HEART, TIMI, GRACE, FRISC, and PURSUIT scores for identifying chest pain due to ACS and for predicting 30-day death or re-infarction in patients arriving through Emergency Medical Services (EMS).
We enrolled consecutive EMS patients evaluated for chest pain at three emergency departments. A reviewer blinded to outcome data retrospectively reviewed patient charts to compute each risk score. The primary outcome was ACS diagnosed during the primary admission, and the secondary outcome was death or re-infarction within 30-days of initial presentation. Our sample included 750 patients (aged 59 ± 17 years, 42% female), of whom 115 (15.3%) had ACS and 33 (4.4%) had 30-day death or re-infarction. The c-statistics of HEART, TIMI, GRACE, FRISC, and PURSUIT for identifying ACS were 0.87, 0.86, 0.73, 0.84, and 0.79, respectively, and for predicting 30-day death or re-infarction were 0.70, 0.73, 0.72, 0.72, and 0.62, respectively. Sensitivity/negative predictive value of HEART ≥ 4 and TIMI ≥ 3 for ACS detection were 0.94/0.98 and 0.87/0.97, respectively.
In chest pain patients admitted through EMS, HEART and TIMI outperform other scores for identifying chest pain due to ACS. Although both have similar negative predictive value, HEART has better sensitivity and lower rate of false negative results, thus it can be used preferentially over TIMI in the initial triage of this population.
许多常用于胸痛评估的临床风险评分并未在急性冠状动脉综合征（ACS）高危患者中得到验证。我们对 HEART、TIMI、GRACE、FRISC 和 PURSUIT 评分进行了独立比较，以确定因 ACS 引起的胸痛，并预测通过急诊医疗服务（EMS）到达的患者 30 天内的死亡或再梗死。
我们连续纳入了三个急诊科评估胸痛的 EMS 患者。一位对结局数据不知情的评审员回顾性地查阅了患者病历，以计算每个风险评分。主要结局是初次就诊时诊断为 ACS，次要结局是初次就诊后 30 天内死亡或再梗死。我们的样本包括 750 名患者（年龄 59±17 岁，42%为女性），其中 115 名（15.3%）患有 ACS，33 名（4.4%）在 30 天内死亡或再梗死。HEART、TIMI、GRACE、FRISC 和 PURSUIT 用于识别 ACS 的 C 统计量分别为 0.87、0.86、0.73、0.84 和 0.79，用于预测 30 天内死亡或再梗死的分别为 0.70、0.73、0.72、0.72 和 0.62。HEART≥4 和 TIMI≥3 对 ACS 检测的敏感性/阴性预测值分别为 0.94/0.98 和 0.87/0.97。
在通过 EMS 入院的胸痛患者中，HEART 和 TIMI 优于其他评分用于识别 ACS 引起的胸痛。尽管两者的阴性预测值相似，但 HEART 的敏感性更高，假阴性结果的发生率更低，因此在该人群的初始分诊中可以优先使用 HEART 而不是 TIMI。
