高敏HEART途径在疑似急性冠状动脉综合征患者各年龄组中的安全性和有效性

Safety and Effectiveness of the High-Sensitivity HEART Pathway Safely Across Age Groups in Patients With Suspected Acute Coronary Syndrome.

作者信息

Supples Michael, Smits Simon, Villenthi Akalya, Snavely Anna C, Ashburn Nicklaus P, Mahler Simon A

机构信息

Department of Emergency Medicine, Wake Forest University School of Medicine (WFUSOM), Winston-Salem, NC.

出版信息

Am J Cardiol. 2025 Apr 25;250:38-47. doi: 10.1016/j.amjcard.2025.04.022.

DOI:10.1016/j.amjcard.2025.04.022

PMID:40288670

Abstract

The high-sensitivity HEART Pathway (hs-HP) is a risk stratification algorithm for Emergency Department (ED) patients with chest pain. However, its diagnostic performance across age subgroups is unknown. We conducted a subgroup analysis of the 5-site hs-HP implementation study. Pre-implementation (1/2019-4/2020) the traditional HEART Pathway was used with contemporary troponins. Postimplementation (11/2020-2/2022) the hs-HP was used with high-sensitivity troponins to risk-stratify patients into rule-out, observation, and rule-in groups. Patients were classified as young (aged: 18 to 45), middle-aged (46 to 64), or older (≥65). Effectiveness and safety outcomes included 30-day hospitalizations and 30-day all-cause mortality or myocardial infarction (MI), respectively. Multivariable logistic regression was used to compare outcomes pre- vs. postimplementation within age subgroups. The 26,126 patients accrued (12,317 pre- and 13,809 postimplementation) were 35.3% non-White and 52.7% female. Postimplementation, hospitalizations decreased 18.1% among the older patients (70.6% vs. 52.5%; aOR 0.47, 95% CI, 0.42 to 0.52), 18.2% in middle-aged (50.0% vs. 31.8%; aOR 0.48, 95% CI, 0.44 to 0.52), and 7.5% among young patients (20.1% vs. 7.6%; aOR 0.69, 95% CI, 0.59 to 0.76). In older patients, 30-day death or MI occurred in 12.9% (497/3,861) postimplementation vs. 13.5% (482/3,571) preimplementation (aOR 1.02; 95% CI, 0.89 to 1.18). In middle-aged patients, 7.0% (382/5,495) had 30-day death or MI postimplementation vs. 7.5% (395/5,257) preimplementation (aOR 1.01; 95% CI, 0.87-1.18). Finally, 30-day death or MI occurred in 1.5% (66/4,453) of young patients postimplementation vs. 2.0% (71/3,489) preimplementation (aOR 1.01; 95% CI 0.69 to 1.48). In conclusion, the hs-HP significantly reduced hospitalizations across all age groups of patients with chest pain, without increasing 30-day adverse events.

摘要

高灵敏度HEART路径（hs-HP）是一种用于急诊科（ED）胸痛患者的风险分层算法。然而，其在不同年龄亚组中的诊断性能尚不清楚。我们对一项5个地点的hs-HP实施研究进行了亚组分析。实施前（2019年1月至2020年4月）使用传统的HEART路径和当代肌钙蛋白。实施后（2020年11月至2022年2月）使用hs-HP和高灵敏度肌钙蛋白将患者风险分层为排除、观察和纳入组。患者分为年轻组（年龄：18至45岁）、中年组（46至64岁）或老年组（≥65岁）。有效性和安全性结果分别包括30天住院率以及30天全因死亡率或心肌梗死（MI）。使用多变量逻辑回归比较年龄亚组实施前后的结果。纳入的26126例患者（实施前12317例，实施后13809例）中，35.3%为非白人，52.7%为女性。实施后，老年患者住院率下降了18.1%（70.6%对52.5%；调整后比值比[aOR]0.47，95%置信区间[CI]，0.42至0.52），中年患者下降了18.2%（50.0%对31.8%；aOR 0.48，95%CI，0.44至0.52），年轻患者下降了7.5%（20.1%对7.6%；aOR 0.69，95%CI，0.59至0.76）。在老年患者中，实施后30天死亡或MI发生率为12.9%（497/3861），实施前为13.5%（482/3571）（aOR 1.02；95%CI，0.89至1.