Gibler W B, Runyon J P, Levy R C, Sayre M R, Kacich R, Hattemer C R, Hamilton C, Gerlach J W, Walsh R A
Department of Emergency Medicine, University of Cincinnati College of Medicine, OH.
Ann Emerg Med. 1995 Jan;25(1):1-8. doi: 10.1016/s0196-0644(95)70347-0.
To evaluate a comprehensive diagnostic 9-hour evaluation (Heart ER Program) for patients with possible acute ischemic coronary syndromes.
Retrospective review of consecutive patients.
Urban tertiary care emergency department.
A total of 1,010 patients with symptoms suggestive of acute ischemic coronary syndrome was enrolled in the Heart ER Program over the first 32 months of operation. Patients with history of coronary artery disease, hemodynamic instability, acute ST-segment elevation or depression of more than 1 mm, or a clinical syndrome consistent with unstable angina were directly admitted to the hospital.
Patients underwent serial testing for creatine kinase (CK-MB) on presentation to the Heart ER and 3, 6, and 9 hours later with continuous 12-lead ECGs/serial ST-segment trend monitoring for 9 hours. Two-dimensional echocardiography and graded exercise testing were performed in the ED after the 9-hour evaluation period.
Of 1,010 patients, 829 (82.1%) were released home from the ED; 153 (15.1%) required admission for further cardiac evaluation. Fifty-two of 153 (33.9%) admitted patients were found to have a cardiac cause for their symptoms; 43 had acute ischemic coronary syndromes (12, acute myocardial infarction; 31, angina or unstable angina).
The Heart ER program provides an effective method for evaluating low- to moderate-risk patients with possible acute ischemic coronary syndrome in the ED setting.
评估针对可能患有急性缺血性冠状动脉综合征患者的一项全面的9小时诊断评估（心脏急诊程序）。
对连续患者进行回顾性研究。
城市三级医疗急诊科。
在该心脏急诊程序运行的前32个月中，共有1010名有急性缺血性冠状动脉综合征症状的患者被纳入。有冠状动脉疾病史、血流动力学不稳定、急性ST段抬高或压低超过1毫米，或临床综合征符合不稳定型心绞痛的患者直接入院。
患者在进入心脏急诊时、3小时后、6小时后及9小时后接受肌酸激酶（CK-MB）的系列检测，并进行连续9小时的12导联心电图/系列ST段趋势监测。在9小时评估期后于急诊科进行二维超声心动图和分级运动试验。
1010名患者中，829名（82.1%）从急诊科出院回家；153名（15.1%）需要入院进行进一步的心脏评估。153名入院患者中有52名（33.9%）被发现其症状有心脏病因；43名患有急性缺血性冠状动脉综合征（12名急性心肌梗死；31名心绞痛或不稳定型心绞痛）。
心脏急诊程序为在急诊科环境中评估可能患有急性缺血性冠状动脉综合征的低至中度风险患者提供了一种有效方法。
