Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department
Por:
McCord, J, Cabrera, R, Lindahl, B, Giannitsis, E, Evans, K, Nowak, R, Frisoli, T, Body, R, Christ, M, deFilippi, CR, Christenson, RH, Jacobsen, G, Alquezar, A, Panteghini, M, Melki, D, Plebani, M, Verschuren, F, French, J, Bendig, G, Weiser, S, Mueller, C
Publicada:
1 feb 2017
Resumen:
Background-The TRAPID-AMI trial study ( High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T ( hs-cTnT) in a 1-hour acute myocardial infarction ( AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score ( m-HS) within this trial.
Methods and Results-Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT ( 99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events ( MACEs) occurred at 30 days ( death or AMI). Low-risk patients had an m-HS <= 3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 ( 60%) patients had an AMI excluded. Of those 777 patients, 515 ( 66.3%) patients had an m-HS <= 3, with 1 ( 0.2%) patient having a MACE, and 262 ( 33.7%) patients had an m-HS <= 4, with 6 ( 2.3%) patients having MACEs ( P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 ( 62.5%) patients had an m-HS <= 3, with 1 ( 0.2%) patient having a MACE, and 248 ( 37.5%) patients had an m-HS >= 4, with 5 ( 2.0%) patients having MACEs ( P=0.03).
Conclusions-Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
Filiaciones:
McCord, J:
Henry Ford Hlth Syst, Henry Ford Heart & Vasc Inst, 2799 West Grand Blvd K-14, Detroit, MI 48202 USA
Cabrera, R:
Henry Ford Hlth Syst, Henry Ford Heart & Vasc Inst, 2799 West Grand Blvd K-14, Detroit, MI 48202 USA
Lindahl, B:
Uppsala Univ, Dept Med Sci, Uppsala, Sweden
Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden
Giannitsis, E:
Univ Heidelberg Hosp, Dept Internal Med Cardiol Angiol & Pulmonol 3, Heidelberg, Germany
Evans, K:
Henry Ford Hosp Hlth Syst, Dept Internal Med, Detroit, MI USA
Nowak, R:
Henry Ford Hlth Syst, Dept Emergency Med, Detroit, MI USA
Frisoli, T:
Henry Ford Hlth Syst, Henry Ford Heart & Vasc Inst, 2799 West Grand Blvd K-14, Detroit, MI 48202 USA
Body, R:
Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England
Christ, M:
Paracelsus Med Univ, Gen Hosp, Dept Emergency & Crit Care Med, Nurnberg, Germany
deFilippi, CR:
Inova Heart & Vasc Inst, Dept Med, Falls Church, VA USA
Christenson, RH:
Univ Maryland, Sch Med, Dept Pathol, Baltimore, MD 21201 USA
Jacobsen, G:
Henry Ford Hlth Syst, Dept Publ Hlth Sci, Detroit, MI USA
Alquezar, A:
Hosp Santa Creu & Sant Pau, Dept Emergency Med, Barcelona, Spain
Panteghini, M:
Univ Milan, Sch Med, Dept Biomed & Clin Sci Luigi Sacco, Milan, Italy
Melki, D:
Karolinska Univ Hosp, Dept Cardiol, Karolinska Inst, Dept Med, Stockholm, Sweden
Plebani, M:
Univ Hosp Padova, Dept Lab Med, Padua, Italy
Verschuren, F:
Clin Univ St Luc, Brussels, Belgium
Catholic Univ Louvain, Brussels, Belgium
French, J:
Liverpool Hosp, Sydney, NSW, Australia
Univ New South Wales, Sydney, NSW, Australia
Bendig, G:
Roche Diagnost Germany, Penzberg, Germany
Weiser, S:
Roche Diagnost Germany, Penzberg, Germany
Mueller, C:
Univ Basel Hosp, Cardiol & Cardiovasc Res Inst Basel, Basel, Switzerland
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