Why the study?
Chest pain is a frequent reason for emergency visits, but myocardial infarction is the final diagnosis in only a minority. The study aimed to evaluate the effectiveness of a 0/1-h hsTnI algorithm in caring for chest pain patients and to describe patient group characteristics.
Does the 0/1-h high-sensitivity cardiac troponin algorithm effectively triage patients presenting with chest pain to rule-out, observation, or rule-in for non-STEMI?
Does the 0/1-h high-sensitivity cardiac troponin algorithm effectively triage patients presenting with chest pain to rule-out, observation, or rule-in for non-STEMI?
The 0/1-h high-sensitivity troponin algorithm safely rules out non-STEMI in nearly half of patients presenting with chest pain to a cardiology outpatient clinic, with a 100% negative predictive value.
Supports outpatient chest pain triage; leaves open need for prospective validation before practice change.
Kontext: Bolest na hrudi patĹĂ mezi nejÄastÄjĹĄĂ dĹŻvody nĂĄvĹĄtÄvy pohotovostnĂch ambulancĂ. Infarkt myokardu (IM) je koneÄnou diagnĂłzou u menĹĄiny tÄchto pacientĹŻ. Vysoce senzitivnĂ metody stanovenĂ srdeÄnĂch troponinĹŻ a na nich zaloĹženĂŠ algoritmy umoĹžnujĂ rychlou diagnostiku a bezpeÄnĂŠ vylouÄenĂ IM. CĂl: Zjistit efektivitu jednohodinovĂŠho (0/1-h) algoritmu v pĂŠÄi o pacienty s bolestmi na hrudi a popsat zĂĄkladnĂ charakteristiky jednotlivĂ˝ch skupin pacientĹŻ. Metody: ProspektivnĂ sledovĂĄnĂ pacientĹŻ vyĹĄetĹovanĂ˝ch pro bolesti na hrudi pomocĂ 0/1-h algoritmu s hsTnI (ADVIA Centaur TNIH, Siemens Healthineers) v akutnĂ ambulanci kardiologickĂŠho oddÄlenĂ. VylouÄeni byli pacienti s infarktem myokardu s elevacemi Ăşseku ST (STEMI) a hemodialyzovanĂ pacienti. Porovnali jsme zastoupenĂ pacientĹŻ ve skupinĂĄch algoritmu a jejich zĂĄkladnĂ charakteristiky. VĂ˝sledky: Od 1. 5 do 31. 6. 2018 bylo 0/1-h algoritmem vyĹĄetĹeno 135 pacientĹŻ. Do skupiny rule-out bylo zaĹazeno 64 pacientĹŻ (47,4 %), do observaÄnĂ skupiny 59 osob (43,7 %) a do skupiny rule-in 12 osob (8,9 %). Infarkt myokardu bez elevacĂ Ăşseku ST (non-STEMI) byl koneÄnou diagnĂłzou u osmi pacientĹŻ (5,9 %), vĹĄichni byly zaĹazeni algoritmem do skupiny rule-in. NegativnĂ prediktivnĂ hodnota testu byla 100 %, pozitivnĂ prediktivnĂ hodnota 75 %. Pacienti zaĹazenĂ do observaÄnĂ skupiny mÄli oproti pacientĹŻm, u kterĂ˝ch byl vylouÄen non-STEMI, vĂce rizikovĂ˝ profil. ZĂĄvÄry: 0/1-h protokol je efektivnĂ v pĂŠÄi o pacienty s bolestmi na hrudi vyĹĄetĹovanĂŠ v ambulanci kardiologickĂŠho oddÄlenĂ. Dovoluje rychlĂŠ a bezpeÄnĂŠ vylouÄenĂ IM u poloviny pĹĂpadĹŻ. Pacienti zaĹazenĂ do observaÄnĂ skupiny, kterĂ˝ch je mĂŠnÄ neĹž polovina, majĂ vĂce rizikovĂ˝ch faktorĹŻ a mÄli by bĂ˝t dĂĄle doĹĄetĹeni. © 2019, ÄKS.
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Málek et al. (2019) studied this question.
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