"假阳性"心脏导管实验室激活在疑似ST段升高心肌梗塞的患者中
David M Larson1, Katie M Menssen, Scott W Sharkey
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.
JAMA
|January 1, 2008
概括
对ST段升高心肌梗塞 (STEMI) 的错误阳性心脏导管实验室激活是常见的. 这凸显了在疑似STEMI病例中需要平衡快速治疗与准确诊断的必要性.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 医疗保健服务研究 医疗服务研究
背景情况:
- 紧急医生直接激活心脏导管实验室对于减少ST段升高心肌梗塞 (STEMI) 门到气球的时间至关重要.
- 关于疑似STEMI的虚假阳性导管实验室激活的频率和影响的数据有限.
- 优化STEMI协议需要了解不必要程序的速度.
研究的目的:
- 确定疑似STEMI患者心脏导管实验室错误阳性激活的患病率.
- 调查这些虚假阳性激活的潜在原因 (病因).
- 评估与虚假阳性激活相关的临床结果.
主要方法:
- 在明尼苏达州的一个区域医疗保健系统中进行了一项前性注册表研究.
- 在第三级心血管中心接受皮肤冠状动脉干预的疑似STEMI患者被招募.
- 从2003年3月到2006年11月收集了数据,其中包括1345名最初注册的患者.
主要成果:
- 在1335名因疑似STEMI而接受血管造影的患者中,14%的人没有冠状动脉罪祸首.
- 9.5%的人缺乏显著的冠状动脉疾病,11.2%的人有负心脏生物标志物.
- 无罪动脉和负生物标志物的组合发生在9.2%的患者中.
结论:
- 对疑似STEMI的错误阳性心脏导管实验室激活在社区环境中相对普遍.
- "假阳性"的定义会影响观察到的频率.
- 目前努力缩短STEMI门到气球的时间也应该解决不必要的导管实验室激活的后果.
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