The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Emre Kudu, Ahmet Enes Kucukardali, Mustafa Altun, Ümit Öztürk, Erhan Altunbaş, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi
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引用次数: 0

Abstract

Background: The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye.

Methods: This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days.

Results: Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as "rule-out," 31.3% as "observe," and 12.3% as "rule-in." The sensitivity and negative predictive value (NPV) for NSTEMI in the "rule-out" group were both 100%. In the "rule-in" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the "rule-out" group, 13.9% in the "observe" group, and 67.0% in the "rule-in" group.

Conclusions: The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes.

Clinical trial number: Not applicable.

在拥挤的急诊科,ESC 0/1小时算法对非st段抬高型心肌梗死的诊断准确性:来自 rkiye单中心的真实世界经验
背景:快速准确地诊断非st段抬高型心肌梗死(NSTEMI)对于改善患者预后和减少急诊科(ED)人满为患至关重要。欧洲心脏病学会(ESC)的0/1小时算法,利用高灵敏度的心肌肌钙蛋白T (hs-cTnT)水平,在国际上表现出很高的诊断性能。本研究旨在评估其在 rkiye大容量ED诊断中的准确性。方法:这项单中心回顾性队列研究于2022年9月1日至12月31日在基耶县马尔马拉大学Pendik培训研究医院进行。出现急性胸部不适并根据ESC 0/1小时算法进行hs-cTnT检测的成年人被纳入研究。排除st段抬高、数据缺失、妊娠或不遵医嘱出院的患者。主要终点为NSTEMI诊断;次要终点为30天内的主要心脏不良事件(MACE)。结果:在3529例符合条件的患者中,有3216例被纳入。患者平均年龄53.9±16.4岁,男性占58.3%。319例(9.9%)患者被诊断为NSTEMI。根据ESC算法,54.4%的患者被分类为“排除”,31.3%的患者被分类为“观察”,12.3%的患者被分类为“正常”。排除组对NSTEMI的敏感性和阴性预测值(NPV)均为100%。规则组特异性为91.16%,阳性预测值(PPV)为59.14%。30天内MACE发生率为13.6%(436例):“排除”组为0.7%,“观察”组为13.9%,“规则”组为67.0%。结论:ESC 0/1小时算法对于排除 rkiye患者的NSTEMI非常有效,具有优异的灵敏度和NPV。虽然它有助于低风险患者的早期出院,但需要加强对中等风险群体的风险分层。其实施可以优化ED资源利用,提高临床疗效。临床试验号:不适用。
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
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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