中国急性胸痛急诊评估与管理评分在急性胸痛患者危险分层中的应用价值

Application value of evaluation and management of patients with acute chest pain in China score in risk stratification for patients with acute chest pain

目的探讨中国急性胸痛急诊评估与管理(EMPACT)评分在急性胸痛患者危险分层中的应用价值。方法按照前瞻性队列研究方法,选取2021年2—4月济宁医学院附属医院胸痛患者548例,按EMPACT评分进行危险分层,终点事件为30 d内主要不良事件(MAE),包括全因死亡、急性心肌梗死(AMI)、紧急血运重建、心脏骤停、心源性休克及其他需要紧急处理危及生命的情况。采用受试者工作特征(ROC)曲线评估EMPACT评分对MAE的预测价值。结果548例患者中,30 d内发生MAE 75例(MAE组),MAE发生率为13.7%;未发生MAE 473例(无MAE组)。MAE组EMPACT评分明显高于无MAE组[8(12,18)分比5(2,8)分],差异有统计学意义(Z=8.94,P<0.01)。Spearman相关分析结果显示,EMPACT评分与MAE的发生呈正相关(r=0.38,P<0.01)。ROC曲线分析结果显示,EMPACT评分预测30 d MAE的曲线下面积为0.820(95%CI 0.770~0.871),截断值为9.5分(由于该评分系统均为整数,截断值取10分),灵敏度为88.6%,特异度为60.0%。结论EMPACT评分有较好的危险分层能力,可实现对急性胸痛患者安全和有效分流。

Objective To explore the application value of evaluation and management of patients with acute chest pain in China(EMPACT)score in risk stratification for patients with acute chest pain.Methods According to the methods of prospective cohort study,548 patients with chest pain in the Affiliated Hospital of Jining Medical University from February to April 2021 were selected.The risk stratification was performed according to EMPACT score.The primary endpoint was the major adverse events(MAE)within 30 d,including death from all causes,acute myocardial infarction(AMI),emergency revascularization,cardiac arrest,cardiogenic shock and other life-threatening situations that need urgent attention.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of EMPACT score for MAE.Results Among the 548 patients,75 cases had MAE within 30 d(MAE group),and the incidence of MAE was 13.7%;473 cases did not occur MAE(non-MAE group).The EMPACT score in MAE group was significantly higher than that in non-MAE group:8(12,18)scores vs.5(2,8)scores,and there was statistical difference(Z=8.94,P<0.01).Spearman correlation analysis result showed that EMPACT score was positively correlated with MAE(r=0.38,P<0.01).ROC curve analysis result showed that the area under the curve of EMPACT score in prediction within 30 d MAE was 0.820(95%CI 0.770 to 0.871),the cut-off value was 9.5 scores(since all the scoring systems were integers,the cut-off value was 10 scores),the sensitivity was 88.6%,and the specificity was 60.0%.Conclusions The EMPACT score has a good risk stratification capability to achieve safe and effective triage of acute chest pain.