Chae Bora, Ahn Shin, Kim Youn-Jung, Ryoo Seung Mok, Sohn Chang Hwan, Seo Dong-Woo, Kim Won Young
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean Circ J. 2023 Sep;53(9):635-644. doi: 10.4070/kcj.2022.0354.
The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department.
We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m² with the conventional threshold of 30 kg/m² in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death.
Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%.
When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.
开发了病史、心电图、年龄、危险因素和肌钙蛋白（HEART）路径，以在因胸痛到急诊科就诊的患者中识别发生重大不良心脏事件（MACE）风险较低的患者。
我们对HEART路径进行了修改，在危险因素中肥胖的定义里，将韩国的25kg/m²临界值替换为传统的30kg/m²临界值。主要结局是30天内发生的MACE，包括急性心肌梗死、初次冠状动脉介入治疗、冠状动脉旁路移植术和全因死亡。
在1304例前瞻性纳入的患者中，320例（24.5%）发生了MACE。改良后的HEART路径将37.3%的患者识别为低风险，而使用HEART路径时这一比例为38.3%。在被HEART路径分类为低风险的500例患者中，8例（1.6%）发生了MACE，在改良HEART路径的486例低风险患者中，4例（0.8%）发生了MACE。与原始HEART路径相比，改良后的HEART路径敏感性为98.8%，阴性预测值（NPV）为99.2%，特异性为49.0%，阳性预测值（PPV）为38.6%，而原始HEART路径敏感性为97.5%，NPV为98.4%，特异性为50.0%，PPV为38.8%。
应用于韩国人群时，改良后的HEART路径通过使用针对韩国人建议的体重指数临界值水平，可以更准确地识别适合早期出院的患者。
