对胸痛患者的ACC专家共识决策途径的验证
Simon A Mahler1, Nicklaus P Ashburn2, Michael W Supples2
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
美国心脏病学会 (ACC) 的胸痛途径对大多数患者来说是安全有效的. 然而,对于已知的冠状动脉疾病 (CAD) 患者来说,它的安全性是可疑的.
科学领域:
- 心脏病学 心脏病学
- 临床途径 临床途径
- 紧急医疗 紧急医疗
背景情况:
- 美国心脏病学会 (ACC) 开发了一种专家共识决策途径,用于管理胸痛.
- 这一途径为诊断和治疗患有胸痛的患者提供了一种标准化的方法.
研究的目的:
- 验证胸痛ACC专家共识决策途径的临床实用性和安全性.
- 评估该通道在现实世界中的性能,多个地点的美国急诊部设置.
主要方法:
- 一项观察性队列研究包括14,395名成年人,涉嫌患有急性冠状动脉综合征,遍及5个美国急诊部.
- 电心电图 (ECG) 和连续高灵敏度托波宁测量用于根据ACC路径进行风险分层.
- 主要安全性终点是30天全因死亡或心肌梗塞 (MI);有效性是根据分层到排除区的比例来衡量.
主要成果:
- 该ACC途径的整体疗效为48.1%.
- 在整体队列中,该途径在30天死亡或心脏病发作时达到99.7%的高负预测值.
- 然而,在已知冠状动脉疾病 (CAD) 的患者中,尽管被分层到排除区,但1.5%的患者死亡或心脏病发作.
结论:
- 胸痛的ACC专家共识决策途径通常是安全有效的.
- 由于潜在的安全问题,建议在已知冠状动脉疾病病史的患者使用该途径时谨慎使用.
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