A predictive instrument using contrast echocardiography in patients presenting to the emergency department with chest pain and without ST-segment elevation.
A predictive instrument using contrast echocardiography in patients presenting to the emergency department with chest pain and without ST-segment elevation.
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DOI：
10.1016/j.echo.2010.03.013
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发表时间：
2010-06
影响因子：
6.5
通讯作者：
Kaul, Sanjiv
中科院分区：
文献类型：
--
作者：
Wei, Kevin;Peters, Dawn;Belcik, Todd;Kalvaitis, Saul;Womak, Lisa;Rinkevich, Diana;Tong, Khim-Leng;Horton, Kenneth;Kaul, Sanjiv
向急诊科（ED）提出疑似心源性胸痛（CP）和未分化心电图（ECG）的患者的风险分层是困难的。我们假设在这些患者中，结合临床、心电图和心肌超声造影（MCE）变量的风险评分可以准确预测未来48小时内发生的不良事件。CP持续≥30分钟且心电图无ST段抬高的患者纳入研究。MCE法评价大鼠的区域功能（RF）和心肌灌注（MP）。在最初的1166例患者（队列1）中建立了风险模型，并在随后的720例患者（队列2）中进行了验证。任何心电图异常或ST段改变（or 2.5, 95% CI: 1.4-4.5, p=0.002, or 2.9, 95% CI: 1.7-4.8, p<0.001）、RF异常伴MP正常（or 3.5, 95% CI: 1.8-6.5, p<0.001）、RF异常伴MP异常（or 9.6, 95% CI: 5.8-16.0, p<0.001）均为非致死性心肌梗死或心源性死亡的重要多因素预测因子。队列1和队列2的风险模型一致性概率估计分别为0.82和0.83。两个队列的风险评分将患者分为5个不同的风险组，事件发生率从0.3%到58%不等。一种简单的预测工具已经开发出来，它可以从临床、心电图和床边MCE的结果中准确预测48小时内出现疑似心源性CP且心电图未诊断为急性缺血性损伤的患者。它的应用可以加强对急诊科CP患者的护理。例如，风险评分为0的患者可以从急诊科出院，无需进一步检查。然而，这需要在多中心研究中得到验证。
Risk stratification of patients presenting to the emergency department (ED) with suspected cardiac chest pain (CP) and an undifferentiated electrocardiogram (ECG) is difficult. We hypothesized that in these patients a risk score incorporating clinical, ECG, and myocardial contrast echocardiography (MCE) variables would accurately predict adverse events occurring within the next 48 hours. Patients with CP lasting for ≥30 min who did not have ST segment elevation on the ECG, were enrolled. Regional function (RF) and myocardial perfusion (MP) were assessed by MCE. A risk model was developed in the initial 1166 patients (cohort 1), and validated in subsequent 720 patients (cohort 2). Any abnormality or ST changes on ECG (OR 2.5, 95% CI:1.4–4.5, p=0.002, and OR 2.9, 95% CI:1.7–4.8, p<0.001, respectively), abnormal RF with normal MP (OR 3.5, 95% CI:1.8–6.5, p<0.001), and abnormal RF with abnormal MP (OR 9.6, 95% CI:5.8–16.0, p<0.001) were found to be significant multivariate predictors of non-fatal myocardial infarction or cardiac death. The estimate of the probability of concordance for the risk model was 0.82 for cohort 1 and 0.83 for cohort 2. The risk score in both cohorts stratified patients into 5 distinct risk groups with event rates ranging from 0.3% to 58%. A simple predictive instrument has been developed from clinical, ECG, and MCE findings obtained at the bedside that can accurately predict events occurring within 48 hours in patients presenting to the ED with suspected cardiac CP and an ECG that is not diagnostic for acute ischemic injury. Its application could enhance care of CP patients in the ED. For instance, patients with a risk score of 0 could be discharged from the ED without further work-up. However, this needs to be validated in a multi-center study.
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