Department of Cardiology, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel, 3109601.
Department of Internal Medicine "B", Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel, 3109601.
Eur Heart J Qual Care Clin Outcomes. 2020 Jul 1;6(3):193-198. doi: 10.1093/ehjqcco/qcaa005.
Patients presenting to the emergency department (ED) with cardiac chest pain and high-sensitive troponin I (HsTnI) less than 5 ng/L have very good prognosis and low risk for major adverse cardiovascular events. The 2015 European Society of Cardiology (ESC) guidelines for non-ST-elevation myocardial infarction (MI)/acute coronary syndrome (ACS) suggests that patients with normal high-sensitive troponin, which are free of chest pain and have a global registry of acute coronary events (GRACE) score less than 140 are eligible for discharge from the hospital for outpatient workup. Our hypothesis suggests that not all patients with GRACE score under 140 should be discharged for ambulatory tests even with undetectable HsTnI as recommended in the guidelines.
Population-based retrospective cohort study in a large tertiary care centre. The study population included all patients discharged from the hospital between 1 February 2016 and 28 February 2019 following rule out of MI. During the study period, a total of 13 800 patients were discharged from the hospital after rule out of MI. Among them, 9236 (67%) had HsTnI below 5 ng/L. A total of 7705 patients (83%) met the criteria for low (n = 7162) or moderate (n = 543) GRACE risk score. Moderate-risk patients had significantly more adverse events than low-risk patients (4.6% vs. 2.1%, P < 0.001). They are in higher risk of death (0.5% vs. 0.1%, P = 0.042), revascularization (3.9% vs. 1.8%, P = 0.0047), and readmission due to ACS (1.1% vs. 0.4%, P = 0.031).
Patients presenting to the ED with chest pain and HsTnI less than 5 ng/L and GRACE score under 140 have 2-4% adverse event in 60 days. The differences between the groups suggest using rapid rule out algorithms for only low-risk patients with GRACE score under 73.
因心脏胸痛而到急诊科就诊且高敏肌钙蛋白 I（HsTnI）小于 5ng/L 的患者预后非常好，发生主要不良心血管事件的风险低。2015 年欧洲心脏病学会（ESC）非 ST 段抬高型心肌梗死（MI）/急性冠状动脉综合征（ACS）指南建议，对于 HsTnI 正常、胸痛消失且全球急性冠状动脉事件登记（GRACE）评分小于 140 的患者，可从医院出院进行门诊检查。我们的假设是，即使按照指南建议 HsTnI 无法检测到，并非所有 GRACE 评分低于 140 的患者都应出院进行门诊检查。
在一家大型三级护理中心进行基于人群的回顾性队列研究。研究人群包括 2016 年 2 月 1 日至 2019 年 2 月 28 日期间 MI 排除后出院的所有患者。在此期间，共有 13800 名患者因 MI 排除后出院。其中，9236 名（67%）患者的 HsTnI 低于 5ng/L。共有 7705 名患者（83%）符合低危（n=7162）或中危（n=543）GRACE 风险评分标准。中危患者的不良事件发生率明显高于低危患者（4.6%比 2.1%，P<0.001）。他们的死亡风险（0.5%比 0.1%，P=0.042）、血运重建风险（3.9%比 1.8%，P=0.0047）和因 ACS 再入院风险（1.1%比 0.4%，P=0.031）更高。
因胸痛且 HsTnI 小于 5ng/L 且 GRACE 评分低于 140 而到急诊科就诊的患者，在 60 天内有 2-4%发生不良事件。两组之间的差异表明，仅对 GRACE 评分低于 73 的低危患者使用快速排除算法。
