Safety and Effectiveness of the High-Sensitivity HEART Pathway Safely Across Age Groups in Patients With Suspected Acute Coronary Syndrome

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-25 DOI:10.1016/j.amjcard.2025.04.022

Michael Supples MD, MPH , Simon Smits BS , Akalya Villenthi MS , Anna C. Snavely PhD , Nicklaus P. Ashburn MD, MS , Simon A. Mahler MD, MS

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Abstract

The high-sensitivity HEART Pathway (hs-HP) is a risk stratification algorithm for Emergency Department (ED) patients with chest pain. However, its diagnostic performance across age subgroups is unknown. We conducted a subgroup analysis of the 5-site hs-HP implementation study. Pre-implementation (1/2019-4/2020) the traditional HEART Pathway was used with contemporary troponins. Postimplementation (11/2020-2/2022) the hs-HP was used with high-sensitivity troponins to risk-stratify patients into rule-out, observation, and rule-in groups. Patients were classified as young (aged: 18 to 45), middle-aged (46 to 64), or older (≥65). Effectiveness and safety outcomes included 30-day hospitalizations and 30-day all-cause mortality or myocardial infarction (MI), respectively. Multivariable logistic regression was used to compare outcomes pre- vs. postimplementation within age subgroups. The 26,126 patients accrued (12,317 pre- and 13,809 postimplementation) were 35.3% non-White and 52.7% female. Postimplementation, hospitalizations decreased 18.1% among the older patients (70.6% vs. 52.5%; aOR 0.47, 95% CI, 0.42 to 0.52), 18.2% in middle-aged (50.0% vs. 31.8%; aOR 0.48, 95% CI, 0.44 to 0.52), and 7.5% among young patients (20.1% vs. 7.6%; aOR 0.69, 95% CI, 0.59 to 0.76). In older patients, 30-day death or MI occurred in 12.9% (497/3,861) postimplementation vs. 13.5% (482/3,571) preimplementation (aOR 1.02; 95% CI, 0.89 to 1.18). In middle-aged patients, 7.0% (382/5,495) had 30-day death or MI postimplementation vs. 7.5% (395/5,257) preimplementation (aOR 1.01; 95% CI, 0.87-1.18). Finally, 30-day death or MI occurred in 1.5% (66/4,453) of young patients postimplementation vs. 2.0% (71/3,489) preimplementation (aOR 1.01; 95% CI 0.69 to 1.48). In conclusion, the hs-HP significantly reduced hospitalizations across all age groups of patients with chest pain, without increasing 30-day adverse events.

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在疑似急性冠脉综合征患者中，高敏感性HEART通路在不同年龄组的安全性和有效性。

高灵敏度心脏路径（hs-HP）是急诊科（ED）胸痛患者的风险分层算法。然而，其诊断跨年龄亚组的性能尚不清楚。我们对5个站点的hs-HP实施研究进行了亚组分析。实施前（2019年1月- 2020年4月）传统的HEART通路与现代肌钙蛋白一起使用。实施后（2020年11月- 2022年2月），将hs-HP与高敏感性肌钙蛋白一起对患者进行风险分层，分为排除组、观察组和规则组。患者分为青年（18 ~ 45岁）、中年（46 ~ 64岁）和老年（≥65岁）。有效性和安全性结果分别包括30天住院和30天全因死亡率或心肌梗死（MI）。使用多变量逻辑回归来比较各年龄组实施前后的结果。累计26126例患者（12,317例实施前和13,809例实施后），其中35.3%为非白人，52.7%为女性。实施后，老年患者住院率下降18.1% (70.6% vs. 52.5%；aOR 0.47, 95% CI, 0.42 ~ 0.52)，中年人18.2%(50.0%比31.8%；aOR为0.48,95% CI为0.44 ~ 0.52)，年轻患者为7.5% (20.1% vs. 7.6%；aOR 0.69, 95% CI, 0.59 ~ 0.76)。在老年患者中，实施后30天死亡或心肌梗死发生率为12.9%(497/3,861)，而实施前为13.5% (482/3,571)(aOR 1.02；95% CI, 0.89 ~ 1.18)。在中年患者中，7.0%（382/ 5495）在实施后30天死亡或心肌梗死，而实施前为7.5% (395/ 5257)(aOR 1.01；95% ci, 0.87-1.18)。最后，实施后年轻患者30天死亡或心肌梗死发生率为1.5%(66/ 4453)，而实施前为2.0% (71/ 3489)(aOR 1.01；95% CI 0.69 ~ 1.48)。总之，hs-HP显著降低了所有年龄组胸痛患者的住院率，没有增加30天的不良事件。

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 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.