Heart and Vascular Institute, Henry Ford Hospital, Dearborn, MI, 48126, USA.
Curr Cardiol Rep. 2020 May 29;22(7):49. doi: 10.1007/s11886-020-01294-1.
As many as 10 million patients present annually to the emergency department in the USA with symptoms concerning for acute myocardial infarction. The use of risk scores for patients with chest pain or equivalent without ST-segment elevation on the electrocardiogram. The adaptation in the USA of high sensitivity troponin assays requires rethinking of how to best optimize troponin testing within a risk score.
Patients are risk stratified using a combination of validated risk scores, biomarkers, and both noninvasive and invasive testing. The advent of high-sensitivity troponins has served to augment existing risk scores in the identification of low-risk patients for early discharge, as well as led to the introduction of new rapid rule-out protocols by which acute myocardial infarction can be excluded by biomarker evaluation more quickly. The emergence of machine learning algorithms may further enhance provider's ability to quickly diagnose or exclude myocardial infarction in the emergency department. The addition of high sensitive troponin assays to established emergency department risk scores is providing new opportunities to improve the timeliness and accuracy of the evaluation of patients presenting with a possible myocardial infarction. Utilizing the time between troponin measures as a variable combined with clinical risk factors with new algorithms may further serve to improve diagnostic accuracy.
在美国，每年有多达 1000 万名患者因疑似急性心肌梗死而到急诊科就诊。对于心电图无 ST 段抬高的胸痛或等效症状患者，使用风险评分。高敏肌钙蛋白检测在美国的应用需要重新考虑如何在风险评分中优化肌钙蛋白检测。
患者通过结合验证过的风险评分、生物标志物以及无创和有创检查进行风险分层。高敏肌钙蛋白的出现有助于通过生物标志物评估更快地排除急性心肌梗死，从而增强现有风险评分对低危患者早期出院的识别能力，并导致新的快速排除方案的引入。机器学习算法的出现可能进一步提高医生在急诊科快速诊断或排除心肌梗死的能力。将高敏肌钙蛋白检测添加到现有的急诊科风险评分中，为改善疑似心肌梗死患者的评估及时性和准确性提供了新的机会。利用肌钙蛋白测量之间的时间作为变量，结合新算法的临床危险因素，可能进一步提高诊断准确性。
