External Validation of the Recalibrated HEART Score for Evaluation of Possible Acute Coronary Syndrome

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Edward Hyun Suh MD , Bryn E. Mumma MD, MAS , Andrew J. Einstein MD, PhD , Betty C. Chang MD, MHA , Phong Anh Huynh MD, MPH , LeRoy E. Rabbani MD , Lauren S. Ranard MD , Dana L. Sacco MD, MSc , Aleksandr M. Tichter MD, MS , Marc A. Probst MD, MS
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Abstract

A single high-sensitivity troponin-T (hs-TnT) measurement may be sufficient to risk-stratify emergency department (ED) patients with possible acute coronary syndrome (ACS) using the recalibrated History, Electrocardiogram, Age, Risk Factors, Troponin (rHEART) score. We sought to validate this approach in a multiethnic population of United States patients and investigate gender-specific differences in performance. We conducted a secondary analysis of a prospective cohort study of adult ED patients with possible ACS at a single, urban, academic hospital. We investigated the diagnostic performance of rHEART for the incidence of type-1 acute myocardial infarction (AMI) and other major adverse cardiac events (MACE) at 30 days, using both single (19 ng/L) and gender-specific (14 ng/L for women, 22 ng/L for men) 99th percentile hs-TnT thresholds. The 821 patients included were 54% women, 57% Hispanic, and 26% Black. Overall, 4.6% of patients had MACE, including 2.4% with AMI. Single-threshold rHEART ≤3 had a sensitivity of 94.4% (95% confidence interval 81% to 99%) and negative predictive values of 99.3% (98% to 100%) for MACE; gender-specific thresholds performed nearly identically. Sensitivity and negative predictive values for AMI were 90.0% (67% to 98%) and 99.3% (97% to 100%). Excluding patients presenting <3 hours from symptom onset improved sensitivity for MACE and AMI to 97.0% (84% to 100%) and 94.1% (71% to 100%). Logistic regression demonstrated odds of MACE increased with higher rHEART scores at a similar rate for men and women. In conclusion, a single initial hs-TnT and rHEART score can be used to risk-stratify male and female ED patients with possible ACS, especially when drawn >3 hours after symptom onset.

用于评估可能的急性冠状动脉综合征的重新校准 HEART 评分的外部验证。
使用重新校准的病史、心电图、年龄、风险因素、肌钙蛋白(rHEART)评分法,一次高敏肌钙蛋白-T(hs-TnT)测量可能就足以对可能患有急性冠状动脉综合征(ACS)的急诊科(ED)患者进行风险分层。我们试图在美国患者的多种族人群中验证这种方法,并研究其性能的性别差异。我们对一家城市学术医院可能患有 ACS 的 ED 成人患者进行了前瞻性队列研究的二次分析。我们采用单一(19 纳克/升)和性别特异性(女性 14 纳克/升,男性 22 纳克/升)hs-TnT 第 99 百分位数阈值,研究了 rHEART 对 30 天内 1 型急性心肌梗死(AMI)和其他主要心脏不良事件(MACE)发生率的诊断性能。纳入的 821 名患者中,54% 为女性,57% 为西班牙裔,26% 为黑人。4.6%的患者发生了MACE,其中2.4%为急性心肌梗死。单一阈值 rHEART ≤ 3 对 MACE 的灵敏度为 94.4%(95% 置信区间,81-99%),阴性预测值 (NPV) 为 99.3%(98-100%);性别特异性阈值的表现几乎相同。急性心肌梗死的灵敏度和 NPV 分别为 90.0% (67-98%) 和 99.3% (97-100%)。排除症状出现后 3 小时内就诊的患者后,对 MACE 和 AMI 的敏感性分别提高到 97.0% (84-100%) 和 94.1% (71-100%)。逻辑回归结果表明,随着 rHEART 评分的升高,男性和女性发生 MACE 的几率也随之升高,且升高的比率相似。总之,单一的初始 hs-TnT 和 rHEART 评分可用于对可能患有 ACS 的男性和女性急诊患者进行风险分层,尤其是在症状发作后 3 小时以上抽血时。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Journal of Cardiology
American Journal of Cardiology 医学-心血管系统
CiteScore
4.00
自引率
3.60%
发文量
698
审稿时长
33 days
期刊介绍: Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.
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