一种新型冠状动脉疾病急诊科患者风险预测工具的开发：一项研究方案

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-06-01 DOI:10.1016/j.cjco.2025.03.016

Andrew D. McRae MD, PhD , Aysha J. Macci BSc , Jessalyn K. Holodinsky PhD , Tolulope T. Sajobi PhD , James E. Andruchow MD, MSc , Bjug Borgundvaag MD, PhD , Steven Brooks MD, MSc , Ivy Cheng MD, PhD , Saswata Deb MD, PhD , Patrick Fok MD , Peter A. Kavsak PhD , Michelle M. Graham MD, MSc , Jacques Lee MD, MSc , Shelley L. McLeod PhD , Frank Scheuermeyer MD, MHSc , Venkatesh Thiruganasambandamoorthy MD, MSc , Hana Wiemer MD , Justin W. Yan MD, MSc , Corinne M. Hohl MDCM, MHSc , Canadian Emergency Department Research Network (CEDRN) and the Network of Canadian Emergency Researchers (NCER)

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引用次数: 0

摘要

伴有胸痛和急性冠状动脉综合征的患者占50%；加拿大每年有60万急诊就诊。在这些患者中，85%没有急性冠状动脉综合征，大多数患者在经过全面评估后出院。然而，这些患者中有很大一部分在急诊科出院后接受了门诊心脏检查，尽管他们发生主要心脏不良事件（MACE）的短期风险，包括死亡、新发心肌梗死和需要血运重建术的风险非常小。这些转诊导致大量低价值医疗保健的利用，并限制了那些更有可能从客观测试中受益的患者的访问。现有的风险预测工具是在新的高灵敏度心肌肌钙蛋白检测出现之前开发的，它们是在非代表性人群中推导出来的，当应用于心肌肌钙蛋白浓度低的ED患者时，系统地高估了MACE的短期风险。这项多中心前瞻性队列研究将纳入伴有胸痛的ED患者，以得出并验证一种新的风险预测工具，该工具可以区分不需要进一步心脏检查的MACE低风险患者和可能受益于额外心脏检查的患者。我们将在13个加拿大急诊科招募6500名患者，并对他们进行前瞻性随访，以确定他们在索引急诊科就诊后30天内MACE的主要结局。本项目开发的风险预测工具将指导急诊科胸痛患者安全、有效和适当的转诊。临床试验注册编号nct06743672。

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Development of a Novel Risk-Prediction Tool for Emergency Department Patients with Symptoms of Coronary Artery Disease: A Research Study Protocol

Patients with chest pain and symptoms of acute coronary syndromes account for > 600,000 emergency department (ED) visits annually in Canada. Of these patients, 85% do not have acute coronary syndromes, and most are discharged from the ED after a thorough evaluation. However, a large proportion of these patients are referred for outpatient cardiac testing after ED discharge, even though their short-term risk of major adverse cardiac events (MACE), including death, new myocardial infarction, and need for revascularization, is very small. These referrals contribute to substantial low-value healthcare utilization, and limit access for those patients who are more likely to benefit from objective testing.

Existing risk-prediction tools—developed prior to the advent of new high-sensitivity cardiac troponin assays—were derived in nonrepresentative populations, and when applied to ED patients with low cardiac troponin concentrations, systematically overestimate the short-term risk of MACE.

This multicentre prospective cohort study will enroll ED patients with chest pain to derive and validate a novel risk prediction tool that distinguishes patients at low risk of MACE who do not require further cardiac testing from those who may benefit from additional cardiac testing. We will enroll 6500 patients in 13 Canadian EDs and prospectively follow them to ascertain a primary outcome of MACE within 30 days after their index ED encounter. The risk-prediction tool developed in this project will guide the safe, efficient, and appropriate referral of ED patients with chest pain.