急性大動脈症候群の診断精度とD-ディマーによる大動脈解剖検出リスクスコア:ADVISED前向きマルチセンター研究
Peiman Nazerian1, Christian Mueller2, Alexandre de Matos Soeiro3
1Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.).
Circulation
|October 15, 2017
まとめ
大動脈解剖検出リスクスコア (ADD-RS) とD-ダイマー (DD) 検査を組み合わせた新しい診断戦略は,急性大動脈症候群 (AAS) を安全に排除することができます. このアプローチは,胸痛患者の診断効率を向上させ,誤診と過剰検査のリスクを軽減します.
科学分野:
- 心血管医学
- 診断用イメージング
- 緊急 医療
背景:
- 急性大動脈症候群 (AAS) は,非特異的な症状を伴う希少で重度の心血管疾患であり,誤診と過剰検査に関する懸念を引き起こします.
- AASの診断に伴うリスクの管理を助けるために,標準化された診断戦略が必要である.
- D-ダイマー (DD) はAASに対して敏感ですが,単独の試験としては不十分です.プレテストの確率評価と統合するには,安全性と効率性に関するさらなる評価が必要です.
研究 の 目的:
- 大動脈解剖検出リスクスコア (ADD-RS) とAASを排除するためのD-ダイマー (DD) 検査を統合した診断戦略の安全性と効率性を評価する.
- AASの診断におけるADD-RS=0/DD-およびADD-RS ≤1/DD-戦略の使用の失敗率と効率を決定する.
主な方法:
- 4カ国の6つの病院で1850人の患者さんを対象とした多センター前向き観察研究 (2014年−2016年).
- AASの疑いのある患者は,ADD-RS (0 - 3) とDDテスト (DD- < 500 ng/ mL) を用いて評価された.
- 結果には,特定のADD-RSとDDの結果に基づいてAASを排除するための診断戦略の失敗率と効率が含まれています.
主要な成果:
- 合計1850人の患者が分析され,そのうち241人 (13%) がAASと診断されました.
- 294人の患者でADD-RS=0/ DD-戦略の失敗率は0. 3% (95%CI,0. 1~1. 9) と有効性は15. 9% (95%CI,14. 3~17. 6) であった.
- 924人の患者でADD-RS ≤1/ DD-戦略の失敗率は0. 3% (95%CI,0. 1〜1) で,有効性は49. 9% (95%CI,47. 7〜52. 2) であった.
結論:
- ADD-RS (ADD-RS=0またはADD-RS ≤1) をDDテストと統合すると,AASを排除するための標準化されたアプローチが得られます.
- この組み合わせ戦略は,疑わしいAASの診断作業において,許容可能な安全性と効率の向上を示しています.
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