紧急医生在非ST升高的急性冠状动脉综合征患者中执行心电图,需要冠状动脉干预的患者
Ting Xu Tan1,2, Donald Wright1, Cristiana Baloescu1
1Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
The western journal of emergency medicine
|January 11, 2024
概括
紧急医生进行的护理点的胸前心脏回声学 (POC TTE) 在识别需要冠状动脉干预的患者中显示出有限的准确性. 然而,POC TTE上的"新"区域壁面运动异常显示出对指导干预决策的高度特异性.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 诊断成像 诊断成像 诊断成像
背景情况:
- 在急诊室 (ED) 找出需要早期冠状动脉干预但不符合标准心电图 (ECG) 标准的患者是具有挑战性的.
- 由急诊医生 (EP) 进行的护理点跨胸腔心声扫描 (POC TTE) 是一个潜在的工具,可以帮助这一识别过程.
研究的目的:
- 评估EP执行的POC TTE在识别最初不符合ECG激活标准的需要冠状动脉干预的患者中的有效性.
- 评估POC TTE在检测区域壁运动异常 (RWMA) 的诊断性能,以指导冠状动脉干预决策.
主要方法:
- 一项回顾性观察队列研究包括了2018-2020年期间向两个EDs提交的成人患者,他们在72小时内接受了POC TTE和冠状动脉血管学.
- 在最初的ED心电图上,符合导管实验室激活标准的患者被排除在外.
- 两个盲人,受过奖学金培训的EP独立审查了RWMA的POC TTE研究,并计算了冠状动脉干预的测试特征.
主要成果:
- 在221名符合条件的患者中,47%接受了冠状动脉干预或冠状动脉旁路移植 (CABG) 转诊.
- 在POC TTE上,RWMA的总体患病率为35%.
- 对于干预/CABG转诊,RWMA的存在具有38%的敏感性和68%的特异性. "新"RWMA显示了43%的灵敏度和93%的特异性. 与心脏病心声图相比,EP执行的RWMA的POC TTE解释具有57%的灵敏度和96%的特异性.
结论:
- 通过EP进行的POC TTE在识别需要冠状动脉干预或CABG转诊的患者方面表现出有限的灵敏度和特异性.
- 检测RWMA的特异性在以前正常回声心脏图的患者中趋向于更高,这表明进一步研究的潜在实用性.
- 与随后的心脏病心声图相比,EP执行的POC TTE在检测RWMA方面具有很高的特异性,因此需要在专门的队列中进一步调查.
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