University of Connecticut School of Medicine, Department of Emergency Medicine, Farmington, CT, United States of America.
Hartford Hospital, Department of Emergency Medicine, Hartford, CT, United States of America.
Am J Emerg Med. 2022 Aug;58:186-191. doi: 10.1016/j.ajem.2022.06.010. Epub 2022 Jun 8.
Electrocardiographically occult occlusive myocardial infarction (OOMI), defined as coronary artery occlusion requiring revascularization without ST-segment elevation on electrocardiogram (ECG), is associated with delayed diagnosis resulting in higher morbidity. Left ventricular (LV) wall motion abnormalities (WMA) appreciated on echocardiography can expedite OOMI diagnosis. We sought to determine whether point-of-care ultrasound (PoCUS) demonstrating WMA expedites revascularization time when performed on emergency department patients being evaluated for OOMI.
This was a single-site retrospective cohort study over a 38-month period. All admitted adult ED patients ≥35 years of age evaluated by the emergency physician with PoCUS for LV function, an ECG, and a standard troponin I biomarker assay were included. Patients with ST-segment elevation myocardial infarction (STEMI), prior LV dysfunction, fever ≥100.4 °F, or hypotension were excluded. A structured chart abstraction was performed for relevant demographic and clinical characteristics.
We screened 1561 ED patients who underwent cardiac PoCUS for eligibility: 874 met exclusion criteria, 453 were discharged, and 234 were included in the analysis. Twenty-three patients had coronary interventions, of which 14 had WMA. PoCUS was performed 36 min (IQR -9-68) before troponin resulted (n = 234) and 39 min (IQR -23-96) before the first troponin elevation (n = 85). Twenty of the 23 patients diagnosed with OOMI had elevated troponins prior to catheterization with time from PoCUS to first troponin elevation of 43 min (IQR 9-263). Of these patients, 11 had WMA identified on PoCUS, and the WMA was appreciated 47 min (IQR 26-255) prior to troponin elevation. The time from ED arrival to revascularization was 673 min (IQR 251-2158); 432 min (IQR 209-1300) among patients with WMA (n = 14) compared with 2158 min (IQR 552-3390) for those without WMA (n = 9).
Cardiac PoCUS may identify OOMI earlier than standard evaluation and may expedite definitive management.
心电图隐匿性闭塞性心肌梗死（OOMI）定义为需要血运重建的冠状动脉闭塞，而心电图（ECG）上无 ST 段抬高。这种情况可能导致诊断延迟，从而导致更高的发病率。超声心动图上观察到的左心室（LV）壁运动异常（WMA）可以加速 OOMI 的诊断。我们旨在确定在因 OOMI 而接受评估的急诊科患者中，即时床旁超声（PoCUS）显示 WMA 是否能加快血运重建时间。
这是一项为期 38 个月的单站点回顾性队列研究。所有符合条件的成年 ED 患者均由急诊医师进行 PoCUS 检查，以评估 LV 功能、心电图和标准肌钙蛋白 I 生物标志物检测。排除 ST 段抬高型心肌梗死（STEMI）、既往 LV 功能障碍、体温≥100.4°F 或低血压的患者。对相关的人口统计学和临床特征进行了结构化图表提取。
我们对 1561 名接受心脏 PoCUS 检查的 ED 患者进行了筛选，以确定其是否符合条件：874 名患者符合排除标准，453 名患者出院，234 名患者纳入分析。23 名患者接受了冠状动脉介入治疗，其中 14 名患者存在 WMA。PoCUS 在肌钙蛋白结果前 36 分钟（IQR-9-68）（n=234）和首次肌钙蛋白升高前 39 分钟（IQR-23-96）（n=85）进行。23 名诊断为 OOMI 的患者中有 20 名在导管插入术前肌钙蛋白升高，从 PoCUS 到首次肌钙蛋白升高的时间为 43 分钟（IQR 9-263）。这些患者中有 11 名在 PoCUS 上发现了 WMA，WMA 在肌钙蛋白升高前 47 分钟（IQR 26-255）被识别。从 ED 到达至血运重建的时间为 673 分钟（IQR 251-2158）；WMA 患者为 432 分钟（IQR 209-1300）（n=14），而无 WMA 患者为 2158 分钟（IQR 552-3390）（n=9）。
心脏 PoCUS 可能比标准评估更早地识别 OOMI，并可能加快明确的治疗。
