三种风险分层评分在急性胸痛患者中的应用价值评价

The application of three different risk stratification scores in 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、心脏(HEART)-Pathway评分、急诊室胸痛评分加速诊断路径(EDACS-ADP)评分在急性胸痛患者风险分层中的应用价值。方法:按照前瞻性研究方法,收集2021年2月1日至4月10日就诊于济宁医学院附属医院急诊科的胸痛患者,根据评分进行风险分层,终点事件为30 d内主要不良事件(MAE)。评估各评分识别高危胸痛的应用价值。结果:本研究共纳入628例患者,30 d内随访结果出现MAE 92例(14.95%)。3种评分与MAE的发生均存在正相关,且以EMPACT评分相关性最高(r=0.41,P<0.001)。EMPACT评分、HEART评分和EDACS评分预测30 d发生MAE的曲线下面积分别为0.834(95%CI:0.790~0.878)、0.763(95%CI:0.710~0.817)、0.635(95%CI:0.578~0.691)。EMPACT评分约登指数最大值为0.561,截断值为9.5分。由于该评分均为整数,以EMPACT评分10分作为区分低危胸痛与高危胸痛的界值。EMPACT评分、HEART-Pathway评分、EDACS-ADP评分识别高危胸痛的灵敏度分别为0.707、0.576、0.783,特异度分别为0.854、0.882、0.509。结论:EMPACT评分对急性胸痛患者有较好的风险分层能力,合理应用能促进急性胸痛患者的安全、有效分流。

Objective To assess the application of three risk stratification scoring systems in evaluation and management of patients with acute chest pain.Methods Patients with chest pain who visited the emergency department of Affiliated Hospital of Jining Medical University from February 2021 to April 2021 were recruited.The risk stratification evaluation was performed with EMPACT,HEART-Pathway and EDACS-ADP scoring systems.The primary endpoint was the major adverse events(MAE)within 30 days.The application values of three scales in identifying high-risk chest pain were evaluated.Results A total of 628 patients with acute chest pain were enrolled,and 92 of them(14.95%)had MAE within 30 days.The scores of three scales were all positively correlated with MAE occurrence,while the EMPACT score had the highest correlation(r=0.41,P<0.001).ROC curve analysis showed that the area under the curve(AUC)of EMPACT score,HEART score and EDACS for predicting MAE within 30 days was 0.834(95%CI:0.790-0.878),0.763(95%CI:0.710-0.817)and 0.635(95%CI:0.578-0.691),respectively.When the cut-off value was 9.5,the Yorden index of EMPACT score was the highest(0.561).Since all the scoring systems used integers,the EMPACT score of 10 was the threshold to distinguish low-risk chest pain from high-risk chest pain.The sensitivity of EMPACT,HEART-Pathway and EDACS-ADP scores in identifying high-risk chest pain patients was 0.707,0.576 and 0.783,and the specificity of them was 0.854,0.882 and 0.509,respectively.Conclusion The EMPACT score has a good risk stratification ability,and it can be used for identifying patients with acute chest pain.