کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
3245955 1589118 2015 10 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Retrospective Evaluation of Two Fast-track Strategies to Rule Out Acute Coronary Syndrome in a Real-life Chest Pain Population
ترجمه فارسی عنوان
ارزیابی برگشتی از دو راهبرد سریع جهت رد سندرم حاد کرونر در یک جمعیت درد قفسه سینه واقعی
کلمات کلیدی
سندرم کرونری حاد حساسیت، اختصاصی، تریاژ، تروپونین سطوح غیر قابل کشف، محدودیت تشخیص
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی طب اورژانس
چکیده انگلیسی

BackgroundThe European Society of Cardiology (ESC) guideline on non-ST-elevation acute coronary syndrome (N-STE ACS) proposed a new ACS rule-out protocol.ObjectivesTo evaluate this new tool, which uses diagnostic levels of high-sensitivity troponin T (hs-TnT; > 14 ng/L) in a slightly modified version and compare this to a recently proposed approach using undetectable levels of hs-TnT to rule out patients.MethodsThere were 534 consecutive patients with suspected ACS included. Protocol 1: symptom duration, hs-TnT at 0 and 6–9 h, Global Registry of Acute Coronary Events (GRACE) score, and symptom status at 6–9 h. Protocol 2: a single blood sample of hs-TnT. The primary endpoint was a discharge diagnosis of ACS by blinded adjudication. Secondary endpoints were ACS re-admission < 30 days and 1-year mortality.ResultsProtocol 1 classified 434/534 (81%) patients, with 27.9% being ruled out. All myocardial infarctions were correctly ruled in, but 15 cases of unstable angina were missed, resulting in a sensitivity and negative predictive value of 87.3% (79.6–92.5%) and 87.6% (80.4–92.9%), respectively. Protocol 2 ruled out 17.5% of the population, yielding a sensitivity and negative predictive value of 94.1% (88.2–97.6%) and 90.8% (81.9–96.2%), respectively. Both protocols correctly ruled in 2/3 patients with ACS re-admission < 30 days and 55/56 1-year fatalities.ConclusionThe present study confirms the diagnostic value of a modified version of the ESC rule-out protocol (Protocol 1) in N-STE ACS patients, but also suggests that a simpler protocol using undetectable levels of hs-TnT (Protocol 2) could provide a similar or even superior sensitivity.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: The Journal of Emergency Medicine - Volume 49, Issue 6, December 2015, Pages 833–842
نویسندگان
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