Kucukardali Ahmet Enes, Boraci Zehra, Kudu Emre, Karacabey Sinan, Sanri Erkman, Denizbasi Arzu
Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Türkiye; Department of Emergency Medicine, Defne Devlet Hastanesi, Hatay, Türkiye.
Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Türkiye; Department of Emergency Medicine, Burhan Nalbantlioglu State Hospital, Kıbrıs, Türkiye.
Am J Emerg Med. 2025 Mar;89:30-35. doi: 10.1016/j.ajem.2024.12.023. Epub 2024 Dec 12.
This study aimed to determine whether myocardial infarction (MI) could be safely diagnosed or excluded within 30 min instead of 1 h.
This single-center, prospective, observational study included patients presenting with non-traumatic chest pain. Patients underwent a thorough evaluation, including medical history, physical exams, ECG, and serial hs-cTn T measurements at 0, 30, and 60 min. Patients were classified into STEMI or further evaluated for NSTEMI-ACS based on ECG results. The hs-cTn T tests placed patients into rule-in, observation, or rule-out groups. Diagnostic performance was assessed using sensitivity and negative predictive value (NPV) to rule out MI (primary endpoints) and specificity and positive predictive value (PPV) to rule in MI (secondary endpoints).
809 patients were analyzed, with a median age of 53 ± 15.9 years, 36.1 % of whom were women. MI was confirmed in 15.6 % of patients. The 0-h/30-min algorithm placed 457 patients in the rule-out group, 222 in observation, and 188 in the rule-in, while the 0-h/1-h algorithm placed 507, 141, and 161 patients, respectively. The 0-h/30-min and 0-h/1-h algorithms showed identical sensitivity [100 % (96.11 %-100 %) and 100 % (99.61 %-100.00 %), respectively] and NPV [100 %] for excluding MI. Both had high specificity in the rule-in group [94.83 % (92.95 %-96.34 %) and 92.31 % (90.08 %-94.17 %)]. The 0-h/30-min algorithm had a superior PPV [71.54 % (64.75 %-77.48 %)] compared to the 0-h/1-h algorithm [66.46 % (60.53 %-71.91 %)].
The 0-h/30-min algorithm is as effective as the 0-h/1-h algorithm in safely ruling out MI and may offer improved diagnostic efficiency in ruling in MI.
本研究旨在确定是否可以在30分钟而非1小时内安全地诊断或排除心肌梗死（MI）。
这项单中心、前瞻性、观察性研究纳入了非创伤性胸痛患者。患者接受了全面评估，包括病史、体格检查、心电图以及在0分钟、30分钟和60分钟时进行的连续高敏肌钙蛋白T（hs-cTnT）测量。根据心电图结果，将患者分为ST段抬高型心肌梗死（STEMI）或进一步评估非ST段抬高型急性冠脉综合征（NSTEMI-ACS）。hs-cTnT检测将患者分为纳入组、观察组或排除组。使用敏感性和阴性预测值（NPV）评估排除MI的诊断性能（主要终点），使用特异性和阳性预测值（PPV）评估纳入MI的诊断性能（次要终点）。
分析了809例患者，中位年龄为53±15.9岁，其中36.1%为女性。15.6%的患者确诊为MI。0小时/30分钟算法将457例患者归入排除组，222例归入观察组，188例归入纳入组；而0小时/1小时算法分别将507例、141例和161例患者归入相应组。0小时/30分钟和0小时/1小时算法在排除MI方面显示出相同的敏感性[分别为100%（96.11%-100%）和100%（99.61%-100.00%）]和NPV[100%]。两者在纳入组中均具有较高的特异性[分别为94.83%（92.95%-96.34%）和92.31%（90.08%-94.17%）]。0小时/30分钟算法的PPV[71.54%（64.75%-77.48%）]优于0小时/1小时算法[66.46%（60.53%-71.91%）]。
0小时/30分钟算法在安全排除MI方面与0小时/1小时算法同样有效，并且在纳入MI方面可能具有更高的诊断效率。
