Incremental value of objective cardiac testing in addition to physician impression and serial contemporary troponin measurements in women.
Incremental value of objective cardiac testing in addition to physician impression and serial contemporary troponin measurements in women.
复制标题
除了医生印象和女性连续当代肌钙蛋白测量之外，客观心脏测试的增量价值。
DOI：
10.1111/acem.12092
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Nagurney,JohnT
中科院分区：
文献类型：
--
作者：
Diercks,DeborahB;Mumma,BrynE;FrankPeacock,W;Hollander,JuddE;Safdar,Basmah;Mahler,SimonA;Miller,ChadwickD;Counselman,FrancisL;Birkhahn,Robert;Schrock,Jon;Singer,AdamJ;Nagurney,JohnT
ObjectivesGuidelines recommend that patients presenting to the emergency department (ED) with chest pain who are at low risk for acute coronary syndrome (ACS) receive an objective cardiac evaluation with a stress test or coronary imaging. It is uncertain whether all women derive benefit from this process. The study aim was to determine the incremental value of objective cardiac testing after serial cardiac markers and physician risk assessment.MethodsWomen enrolled in the 18‐site Myeloperoxidase in the Diagnosis of Acute Coronary Syndrome (MIDAS) study had serial troponin I measured at time 0 and 90 minutes and physician risk assessment for the presence of ACS. Risk estimates obtained at the time of ED evaluation were dichotomized as high or non–high risk. The primary outcome was the composite of acute myocardial infarction (AMI) or revascularization at 30 days. Logistic regression with receiver operator characteristic (ROC) curves and net reclassification index were used to determine the diagnostic accuracy for the composite outcome of 30‐day MI or revascularization for two models: 1) troponin I results and physician risk assessment alone and 2) troponin I results, physician risk assessment, and objective cardiac testing.ResultsA total of 460 women with a median age 58 years (interquartile range [IQR] = 48.5 to 68 years) were included, and 32 (6.9%) experienced AMI or revascularization by 30 days. Comparison of the area under the ROC curves (AUC) showed that the addition of objective cardiac testing to the combination of troponin I results and physician risk assessment did not significantly improve prediction of 30‐day AMI or revascularization (AUC = 0.85 vs. 0.89; p = 0.053). Using a threshold of 1%, net reclassification index showed that the addition of objective cardiac testing to troponin I results and physician risk assessment worsened the prediction for 30‐day AMI and revascularization. All of the reclassified patients were false positives, with nine (2.1%) patients incorrectly reclassified from <1% risk to ≥1% risk of 30‐day AMI or revascularization.ConclusionsIn the era of contemporary troponin assays, objective cardiac testing after an ED clinician risk assessment of non–high risk and negative troponin I results at 0 and 90 minutes does not improve the prediction of 30‐day AMI or revascularization in women presenting with chest pain or other symptoms of cardiac ischemia.
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DOI：
--
发表时间：
1998-05
期刊：
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
影响因子：
--
作者：
C. Santana-Boado;J. Candell‐Riera;J. Castell‐Conesa;S. Aguadé-Bruix;A. García-Burillo;T. Canela;Jose M. Gonzalez;J. Cortadellas;D. Ortega;J. Soler‐Soler
通讯作者：
C. Santana-Boado;J. Candell‐Riera;J. Castell‐Conesa;S. Aguadé-Bruix;A. García-Burillo;T. Canela;Jose M. Gonzalez;J. Cortadellas;D. Ortega;J. Soler‐Soler
血管造影记录的冠状动脉疾病的分级运动压力测试
影响因子：
37.8
作者：
A. Bartel;V. Behar;R. Peter;E. Orgain;Y. Kong
通讯作者：
Y. Kong
髓过氧化物酶在急性冠状动脉综合征诊断中的作用：谱的重要性。
影响因子：
4.8
作者：
W. Peacock;J. Nagurney;R. Birkhahn;A. Singer;N. Shapiro;J. Hollander;T. Glynn;R. Nowak;B. Safdar;Chadwick D Miller;M. Peberdy;F. Counselman;A. Chandra;J. Kosowsky;J. Neuenschwander;J. Schrock;S. Plantholt;E. Lewandrowski;Vance Wong;K. Kupfer;D. Diercks
通讯作者：
D. Diercks
影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Vasan, Ramachandran S.
通讯作者：
Vasan, Ramachandran S.
影响因子：
2.1
作者：
Makaryus, Amgad N;Shaw, Leslee J;Mieres, Jennifer H
通讯作者：
Mieres, Jennifer H