Roetger Abby E, McKinney Christopher D, Winter Iii De B, Lewis Charmaine, Swiger Kristopher, Corbett Claire M, Hall Gregory, David Adam, Gratton Austin
Institute of Safety and Quality, Novant Health, Wilmington, N.C., USA.
Department of Pathology, Novant Health New Hanover Regional Medical Center, Wilmington, N.C., USA.
Heliyon. 2024 Sep 28;10(20):e38164. doi: 10.1016/j.heliyon.2024.e38164. eCollection 2024 Oct 30.
The purpose of this study was to assess the impact of adoption of a new cardiac chest pain pathway that included hs-cTnI in the emergency department (ED) when evaluating chest pain patients.
A new pathway incorporating both hs-cTnI testing (Seimens Healthineers Atellica) and risk stratification tools was developed. The impact of the new algorithm was assessed through a retrospective observational review of patients admitted to the ED with chest pain before implementation and after implementation. Before implementation, the conventional Seimens troponin Vista assay was utilized without a defined algorithmic approach. Bivariate analyses were performed comparing the time periods to determine differences in patient discharge dispositions, length of stay, outcomes, and rate of diagnostic cardiac catheterization.
The proportion of patients discharged from the ED increased while the proportion of patients placed in observation or admitted as in-patient decreased. Variation amongst providers regarding patient disposition decreased. The stress testing rate of patients placed in observation decreased over baseline. There was no change in 30-day MACE rate, but there was a decrease in 30-day MI rate.
The new standardized hs-cTnI algorithm approach is safe as demonstrated by no change in 30-day MACE and is also more appropriate and efficient for patients presenting to the ED with chest pain compared to the non-standardized approach with cTnI used previously.
本研究旨在评估在急诊科（ED）评估胸痛患者时采用包含高敏心肌肌钙蛋白I（hs-cTnI）的新型心脏胸痛诊疗路径的影响。
开发了一种结合hs-cTnI检测（西门子医疗Atellica）和风险分层工具的新路径。通过对实施前后因胸痛入住急诊科的患者进行回顾性观察性研究，评估新算法的影响。实施前，使用传统的西门子肌钙蛋白Vista检测法，未采用明确的算法方法。进行双变量分析以比较不同时间段，确定患者出院处置、住院时间、结局和诊断性心导管插入术发生率的差异。
从急诊科出院的患者比例增加，而接受观察或住院的患者比例下降。医护人员之间在患者处置方面的差异减少。接受观察的患者的压力测试率较基线下降。30天主要不良心血管事件（MACE）发生率无变化，但30天心肌梗死（MI）发生率下降。
新的标准化hs-cTnI算法方法是安全的，30天MACE无变化即证明了这一点，并且与先前使用cTnI的非标准化方法相比，对于因胸痛就诊于急诊科的患者也更合适、更高效。
