McRae Andrew D, Macci Aysha J, Holodinsky Jessalyn K, Sajobi Tolulope T, Andruchow James E, Borgundvaag Bjug, Brooks Steven, Cheng Ivy, Deb Saswata, Fok Patrick, Kavsak Peter A, Graham Michelle M, Lee Jacques, McLeod Shelley L, Scheuermeyer Frank, Thiruganasambandamoorthy Venkatesh, Wiemer Hana, Yan Justin W, Hohl Corinne M
Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
CJC Open. 2025 Mar 26;7(6):777-783. doi: 10.1016/j.cjco.2025.03.016. eCollection 2025 Jun.
Patients with chest pain and symptoms of acute coronary syndromes account for > 600,000 emergency department (ED) visits annually in Canada. Of these patients, 85% do not have acute coronary syndromes, and most are discharged from the ED after a thorough evaluation. However, a large proportion of these patients are referred for outpatient cardiac testing after ED discharge, even though their short-term risk of major adverse cardiac events (MACE), including death, new myocardial infarction, and need for revascularization, is very small. These referrals contribute to substantial low-value healthcare utilization, and limit access for those patients who are more likely to benefit from objective testing.Existing risk-prediction tools-developed prior to the advent of new high-sensitivity cardiac troponin assays-were derived in nonrepresentative populations, and when applied to ED patients with low cardiac troponin concentrations, systematically overestimate the short-term risk of MACE.This multicentre prospective cohort study will enroll ED patients with chest pain to derive and validate a novel risk prediction tool that distinguishes patients at low risk of MACE who do not require further cardiac testing from those who may benefit from additional cardiac testing. We will enroll 6500 patients in 13 Canadian EDs and prospectively follow them to ascertain a primary outcome of MACE within 30 days after their index ED encounter. The risk-prediction tool developed in this project will guide the safe, efficient, and appropriate referral of ED patients with chest pain.
NCT06743672.
在加拿大，每年有超过60万例胸痛及急性冠脉综合征症状的患者前往急诊科就诊。在这些患者中，85%没有急性冠脉综合征，大多数患者在经过全面评估后从急诊科出院。然而，尽管这些患者发生包括死亡、新发心肌梗死和血运重建需求在内的主要不良心脏事件（MACE）的短期风险非常低，但其中很大一部分患者在急诊科出院后仍被转诊进行门诊心脏检查。这些转诊导致了大量低价值医疗资源的利用，并限制了那些更有可能从客观检查中获益的患者获得检查的机会。现有的风险预测工具——在新型高敏心肌肌钙蛋白检测方法出现之前开发——是在非代表性人群中得出的，当应用于心肌肌钙蛋白浓度较低的急诊科患者时，会系统性地高估MACE的短期风险。这项多中心前瞻性队列研究将纳入有胸痛症状的急诊科患者，以得出并验证一种新型风险预测工具，该工具可区分不需要进一步心脏检查的低MACE风险患者和可能从额外心脏检查中获益的患者。我们将在加拿大的13家急诊科招募6500名患者，并对他们进行前瞻性随访，以确定他们在首次急诊科就诊后30天内发生MACE的主要结局。本项目开发的风险预测工具将指导对有胸痛症状的急诊科患者进行安全、高效且恰当的转诊。
NCT06743672
