大动脉解剖检测风险评分加D-Dimer对急性大动脉综合征的诊断准确性:ADVISED前性多中心研究
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
概括
结合主动脉剖析检测风险评分 (ADD-RS) 和D-二次体 (DD) 测试的新诊断策略可以安全排除急性主动脉综合征 (AAS). 这种方法提高了胸痛患者的诊断效率,减少了误诊和过度测试的风险.
科学领域:
- 心血管医学
- 诊断成像
- 紧急医疗
背景情况:
- 急性大动脉综合征 (AAS) 是一种罕见的,严重的心血管紧急情况,具有非特异性症状,导致误诊和过度测试的担忧.
- 需要标准化的诊断策略来帮助医生管理与AAS诊断相关的风险.
- 对于AAS,DD是敏感的,但作为一个独立的测试是不够的;其与预测概率评估的整合需要进一步评估安全性和效率.
研究的目的:
- 评估一项诊断策略的安全性和有效性,该策略将大动脉剖析检测风险评分 (ADD-RS) 与D-二聚体 (DD) 测试结合起来,以排除AAS.
- 确定使用ADD-RS=0/DD-和ADD-RS ≤1/DD-策略诊断AAS的失败率和效率.
主要方法:
- 一项多中心前性观察研究,涉及4个国家的6家医院的1850名门诊患者 (2014-2016).
- 使用ADD-RS (0 - 3) 和DD测试 (DD- < 500 ng/ mL) 进行评估.
- 结果包括基于特定ADD-RS和DD结果排除AAS的诊断策略的失败率和效率.
主要成果:
- 总共分析了1850名患者,其中241名 (13%) 被诊断为AAS.
- 在294名患者中,ADD-RS=0/ DD-策略的失败率为0. 3% (95% CI,0. 1- 1. 9) 和效率为15. 9% (95% CI,14. 3- 17. 6).
- 在924名患者中,ADD-RS ≤1/ DD- 策略的失效率为0. 3% (95% CI,0. 1 - 1) 和效率为49. 9% (95% CI,47. 7 - 52. 2).
结论:
- 将ADD-RS (ADD-RS=0或ADD-RS ≤1) 与DD测试相结合,提供了一个标准化的方法来排除AAS.
- 这种联合策略表明可接受的安全性和在疑似AAS的诊断工作中提高的效率.
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