Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.
In: Circulation. Cardiovascular Quality and Outcomes, Vol. 10, no. 2, p. e003101 [1-8] (2017, 2017
Online
academicJournal
Zugriff:
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.
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Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department.
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Autor/in / Beteiligte Person: | McCord, James ; Cabrera, Rafael ; Lindahl, Bertil ; Giannitsis, Evangelos ; Evans, Kaleigh ; Nowak, Richard ; Frisoli, Tiberio ; Body, Richard ; Christ, Michael ; deFilippi, Christopher R ; Christenson, Robert H ; Jacobsen, Gordon ; Alquezar, Aitor ; Panteghini, Mauro ; Melki, Dina ; Plebani, Mario ; Verschuren, Franck ; French, John ; Bendig, Garnet ; Weiser, Silvia ; Mueller, Christian ; UCL - SSS/IREC/MEDA - Pôle de médecine aiguë ; UCL - (SLuc) Service des urgences |
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Zeitschrift: | Circulation. Cardiovascular Quality and Outcomes, Vol. 10, no. 2, p. e003101 [1-8] (2017, 2017 |
Veröffentlichung: | Lippincott Williams & Wilkins, 2017 |
Medientyp: | academicJournal |
ISSN: | 1941-7713 (print) ; 1941-7705 (print) |
DOI: | 10.1161/CIRCOUTCOMES.116.003101 |
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