为急诊室胸痛患者推导一个HEAR途径,以安全地避免第二次热素测试
Chen Chen1, Yao Yu1, Dongxu Chen1
1Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Diagnostics (Basel, Switzerland)
|October 28, 2023
概括
通过使用病史,心电图,年龄和风险因素,结合初始托罗邦尼T水平的新HEAR评分途径,可以在怀疑心肌梗塞病例中安全地减少重复托罗邦尼测试的需要.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 诊断测试 诊断测试 诊断测试
背景情况:
- 怀疑非ST升高心肌梗塞 (NSTEMI) 在急诊室的诊断往往需要连续的激素测试.
- 这种方法增加了医疗保健成本和患者等待时间.
- 开发高效,安全的诊断策略至关重要.
研究的目的:
- 开发和验证一个使用HEAR分数和基线高灵敏心脏托洛T (hs-cTnT) 的决策途径,以安全排除NSTEMI.
- 为了减少急诊室患者进行第二次托罗邦尼测试的需要.
主要方法:
- 对7131名疑似NSTEMI患者的回顾性分析.
- 使用贝叶斯方法开发一个HEAR路径 (历史,心电图,年龄,风险因素).
- 对指数访问NSTEMI和180天主要不良心血管事件 (MACE) 的路径性能评估.
主要成果:
- 在HEAR路径中,NSTEMI的索引访问显示了100.0%的负预测值.
- 180天MACE的假阴性率为0.40%.
- 与<5 ng/L hs-cTnT 策略相比,HEAR 途径减少了 18.2% 的第二次热素测试的需要.
结论:
- 集成临床数据和初始hs-cTnT的HEAR途径提供了一种安全有效的方法,以避免在疑似NSTEMI中进行连续激素测试.
- 这一策略可以显著减少诊断工作量,提高急诊室的效率.
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