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在疑似NSTEMI患者中ESC 0/1 hs-cTnI算法的性能,正常与异常心电图
Zi-Qiu Feng1, Fen Xu1, Ye-Nan Fu1
1Center of Laboratory Medicine, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, China.
高灵敏性ESC 0/1-h心脏托波宁I算法在急诊患者中有效排除心肌梗塞. 然而,缺血性心电图的较低特异性需要仔细的临床相关性,以避免假阳性.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 生物标志物研究 生物标志物研究
背景情况:
- 非ST段升高心肌梗塞 (NSTEMI) 诊断依赖于连续的心脏托罗邦素测量.
- 高灵敏性心脏素I (hs-cTnI) 测定和ESC 0/1-h协议等算法旨在在紧急情况下加快诊断.
- 最初的心电图 (ECG) 发现可以影响诊断准确性和患者风险分层.
研究的目的:
- 评估欧洲心脏病学会 (ESC) 0/1小时 hs-cTnI算法的诊断和预后性能.
- 在怀疑NSTEMI的患者中,根据最初的ECG发现分层评估算法性能.
- 确定算法在预测短期 (30天) 和中期 (180天) 结果中的实用性.
主要方法:
- 对1535名疑似患有急性冠状动脉综合征 (ACS) 的患者进行了回顾性分析.
- 患者分为正常 (n=888) 或异常 (n=647) 的心电图组;异常组进一步分为缺血和非缺血.
- 评估了诊断性能 (灵敏度,特异性,NPV,PPV) 和死亡率和MACE的预后值.
主要成果:
- 在异常心电图组中,灵敏度优异 (100%) 和负预测值 (NPV);在正常心电图组中,灵敏度为98.8%和NPV为99.5%.
- 与正常心电图 (91.6%) 相比,患有缺血性心电图变化 (81.2%) 的患者的特异性较低.
- 在正常心电图组中,观察到女性,早期呈现者 (疼痛发作≤3小时) 和年轻患者 (≤65岁) 的敏感性略低.
结论:
- ESC 0/1-h hs-cTnI算法在所有心电图呈现中显示出高规则排除安全性.
- 缺血性心电图表现型的较低特异性需要临床整合,以防止假阳性规则.
- 对于在特定的正常-ECG子组中潜在的不足检测,需要保持警.
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