A 0-Hour/1-Hour Protocol for Safe, Early Discharge of Chest Pain Patients
A 0-Hour/1-Hour Protocol for Safe, Early Discharge of Chest Pain Patients
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DOI：
10.1111/acem.13224
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发表时间：
2017-08-01
影响因子：
4.4
通讯作者：
Ekelund, Ulf
中科院分区：
文献类型：
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作者：
Mokhtari, Arash;Lindahl, Bertil;Ekelund, Ulf
目的：指南建议急性胸痛患者采用0小时/1小时高灵敏度心肌肌钙蛋白T（hs-cTnT）诊断策略。然而，当与临床风险分层相结合时，关于这种策略的性能的数据很少。我们的目的是评估的诊断准确性的加速诊断协议（ADP）使用0小时/1小时的高敏cTnT的战略，再加上适应溶栓心肌梗死（TIMI）评分和心电图（ECG）排除主要不良心脏事件（MACE）在30 days.Methods：这项前瞻性观察性研究纳入连续急诊科（艾德）胸痛患者。收集TIMI评分变量、艾德医生对ECG的评估以及0和1小时hs-cTnT。30 d MACE定义为急性心肌梗死（AMI）、不稳定型心绞痛（UA）、心源性休克、室性心律失常、房室传导阻滞、心脏骤停、心源性死亡或不明原因死亡。调整后的TIMI评分
Objectives: Guidelines recommend a 0-hour/1-hour high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There are, however, little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0-hour/1-hour hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and electrocardiogram (ECG) for ruling out major adverse cardiac events (MACE) within 30 days.Methods: This prospective observational study enrolled consecutive emergency department (ED) chest pain patients. TIMI score variables, ED physicians' assessments of the ECG, and 0-and 1-hour hs-cTnT were collected. Thirty-day MACE was defined as acute myocardial infarction (AMI), unstable angina (UA), cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause.Results: A total of 1,020 patients were included in the final analysis. The combination of an adapted TIMI score