A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS） in the emergency department （ED）.Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events （MACE） defined as a composite of acute myocardial infarction （AMI）, percu-taneous intervention （PCI）, coronary artery bypass graft （CABG）, or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients （46.6%） had a MACE within three months： 205 patients （15.8%） were diag-nosed with AMI, 465 patients （35.8%） underwent PCI, and 119 patients （9.2%） underwent CABG. There were 10 （0.8%） deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased （P ＆lt; 0.001 byχ2 for trend）. The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups： low risk （score 0-2）, intermediate risk （score 3-4）, and high risk （score 5-10）. Event rates were 1.1%, 18.5%, and 67.0%, respectively （P ＆lt; 0.001）.ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Etiology of non-traumatic acute abdomen in pediatric emergency departments

Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, HenochSchnlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

Takotsubo cardiomyopathy misdiagnosed as acute myocardial infarction under the Chest Pain Center model:A case report

BACKGROUND With the spread and establishment of the Chest Pain Center in China,adhering to the idea that“time is myocardial cell and time is life”,many hospitals have set up a standardized process that ensures that patients with acute myocardial infarction(AMI)who meet emergency percutaneous coronary intervention(PCI)guidelines are sent directly to the DSA room by the prehospital emergency doctor,saving the time spent on queuing,registration,payment,re-examination by the emergency doctor,and obtaining consent for surgery after arriving at the hospital.Takotsubo cardiomyopathy is an acute disease that is triggered by intense emotional or physical stress and must be promptly differentiated from AMI for its appropriate management.CASE SUMMARY A 52-year-old female patient was taken directly to the catheterization room to perform PCI due to 4 h of continuous thoracalgia and elevation of the ST segment in the V3–V5 lead,without being transferred to the emergency department according to the Chest Pain Center model.Loading doses of aspirin,clopidogrel and statins were administered and informed consent for PCI was signed in the ambulance.On first look,the patient looked nervous in the DSA room.Coronary angiography showed no obvious stenosis.Left ventricular angiography showed that the contraction of the left ventricular apex was weakened,and the systolic period was ballooning out,showing a typical“octopus trap”change.The patient was diagnosed with Takotsubo cardiomyopathy.Five days later,the patient had no symptoms of thoracalgia,and the serological indicators returned to normal.She was discharged with a prescription of medication.CONCLUSION Under the Chest Pain Center model for the treatment of patients with chest pain showing ST segment elevation,despite the urgency of time,Takotsubo cardiomy-opathy must be promptly differentiated from AMI for its appropriate management.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.

Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest pain.METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit.At admission,investigators performed a standardized interview and recorded14 chest pain features.Based on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and categorically.As the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to rule-out.In order to assess reproducibility,a second cardiologist did the same procedure.RESULTS In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of accuracy.Accordingly,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

The early risk stratification of the patients with acute chest pain

Objective： This investigation was designed to stratify patients with acute chest pain based on their symptoms, electrocardiogram （ECG）, cardiac injury markers and the number of accompanying traditional risk factors（smoking, obesity, hyperlipemia, hypertension, diabetes）, and to assess the effect of the above factors to obtain a risk stratification for patients with chest pain. Methods： We identified 139 patients with acute chest pain, including 45 myocardiac infarction patients, 65 unstable angina patients and 29 chest pain patients without identified acute coronary syndrome（ACS） admitted to our Coronary Heart Center during December 2004 to February 2005. All patients accepted coronary angiography. All data was collected using questionnaires. Based on reported symptom, electrocardiogram （ECG）, cardiac injury markers and the number of the accompanying traditional risk factors, we stratified all patients into four groups： Group 1, patients with acute chest pain, ECG changes and abnormal cardiac injury biomarkers. Group 2, patients with acute chest pain and ECG changes（without abnormal cardiac injury biomarkers）. Group 3, patients with acute chest pain, normal ECG, normal cardiac injury biomarkers and 〉2 traditional risk factors. Group 4, patients with acute chest pain, normal ECG and normal cardiac injury biomarkers, but only ≤ 2 traditional risk factors. From this data we examined the difference of ACS incidence in the four groups. Results：After stratification the ACS incidence of the grouped patients in turn was 100%, 84%, 69.6% and 53.3%. The combination of early phase ECG and cardiac injury markers identified 70.9% patients with ACS（the specificity being 90.7%）. The mortality of group 3 was higher compared with group 4（69.6% vs 53.3%）, however the P value was more than 0.05 and didn＇ t show significant statistical difference. The correlation analysis found the number of the traditional risk factors had a significant positive correlation （r= 0.202, P = 0.044） with the number of stenosis being more than 50% of the artery diameter. Multiple linear regression showed the hypertension had a significant correlation with the number of the diseased regions（P= 0.014）. Conclusions：The risk stratification based on the symptom, ECG, cardiac injury markers and accompanying traditional risk factors is both important and available in practice. It is unsuitable for patients with a normal ECG and cardiac injury markers to differentiate ACS from non-cardiac chest pain relying only on the number of the accompanying traditional risk factors. However we found the number of the risk factors can indicate the disease severity.

New scoring system for acute chest pain risk stratification: Is it worth SVEAT-ing it?

The emergency room is a very potent environment in the hospital.With the growing demands of the population,improved accessibility to health resources,and the onslaught of the triple pandemic,it is extremely crucial to triage patients at presentation.In the spectrum of complaints,chest pain is the commonest.Despite it being a daily ailment,chest pain brings concern to every physician at first.Chest pain could span from acute coronary syndrome,pulmonary embolism,and aortic dissection(all potentially fatal)to reflux,zoster,or musculoskeletal causes that do not need rapid interventions.We often employ scoring systems such as GRACE/PURSUIT/TIMI to assist in clinical decision-making.Over the years,the HEART score became a popular and effective tool for predicting the risk of 30-d major adverse cardiovascular events.Recently,a new scoring system called SVEAT was developed and compared to the HEART score.We have attempted to summarize how these scoring systems differ and their generalizability.With an increasing number of scoring systems being introduced,one must also prevent anchorage bias;i.e.,tools such as these are only diagnosis-specific and not organ-specific,and other emergent differential diagnoses must also be kept in mind before discharging the patient home without additional workup.

The Role of Bedside Troponin T Test for Identification of High Risk Patients With Acute Chest Pain

Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain.Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group. The odds ratio of acute heart failure of positive group vs. negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31 patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.

Fish bone-induced myocardial injury leading to a misdiagnosis of acute myocardial infarction: A case report

BACKGROUND Acute chest pain(ACP)is very common among patients presenting to emergency departments.Nevertheless,ACP caused by esophageal foreign body is relatively rarely reported.CASE SUMMARY A 56-year-old man suffering from chest pain(increased pain for the last 9 h)was admitted to our hospital on October 25,2015.After undergoing physical examination and laboratory blood testing,he was diagnosed with acute anterior myocardial infarction.Consequently,the patient underwent emergency percutaneous coronary angiography;however,no myocardial infarction signs were observed.Later on,the patient experienced respiration failure and therefore was transferred to intensive care unit.Cardiac ultrasound showed pericardial effusion,which was considered as the cause of shock.He then underwent pericardium puncture drainage and the circulation temporarily improved.Nevertheless,persistent pericardial bleeding,unclear bleeding causes,and clot formation induced poor drainage led to worsening of cardiac tamponade symptoms.Consequently,the patient underwent emergency exploratory thoracotomy,which revealed a fish bone causing pericardial bleeding.The bone was removed,and the damaged blood vessels were mended.Eventually,the patient was discharged in good clinical condition.CONCLUSION For patients with chest pain,it is necessary to consider the possibility of foreign body in the esophagus or even in the heart.Careful history taking and the corresponding inspection can help to avoid unnecessary damage and safeguard patients from unnecessary pain.

Pheochromocytoma in a 49-year-old woman presenting with acute myocardial infarction:A case report

BACKGROUND Pheochromocytoma is a rare endocrine tumor arising from chromaffin cells and having extensive and profound effects on the cardiovascular system by continuously or intermittently releasing catecholamines.The clinical manifestations of pheochromocytoma are diverse,and the typical triad,including episodic headache,palpitations,and sweating,only occurs in 24%of pheochromocytoma patients,which often misleads clinicians into making an incorrect diagnosis.We herein report the case of a patient with intermittent chest pain and elevated myocardial enzymes for 2 years who was diagnosed with pheochromocytoma.CASE SUMMARY A 49-year-old woman presented with intermittent chest pain for 2 years.Two years ago,the patient experienced chest pain and was diagnosed with acute myocardial infarction,with 25%stenosis in the left circumflex.The patient still had intermittent chest pain after discharge.Two hours before admission to our hospital,the patient experienced chest pain with nausea and vomiting,lasting for 20 min.Troponin I and urinary norepinephrine and catecholamine levels were elevated.An electrocardiogram indicated QT prolongation and ST-segment depression in leads II,III,aVF,and V3-V6.A coronary computed tomography angiogram revealed no evidence of coronary artery disease.Echocardiography showed left ventricular enlargement and a decreased posterior inferior wall motion amplitude.Contrast-enhanced computed tomography demonstrated an inhomogeneous right adrenal mass.The patient successfully underwent laparoscopic right adrenalectomy,and histopathology confirmed adrenal pheochromocytoma.During the first-year follow-up visits,the patient was asymptomatic.The abnormal changes on echocardiography and electro-cardiogram disappeared.CONCLUSION Clinicians should be aware of pheochromocytoma.A timely and accurate diagnosis of pheochromocytoma is essential for alleviating serious cardiac complications.

SVEAT score outperforms HEART score in patients admitted to a chest pain observation unit

BACKGROUND Timely and accurate identification of subgroup at risk for major adverse cardiovascular events among patients presenting with acute chest pain remains a challenge.Currently available risk stratification scores are suboptimal.Recently,a new scoring system called the Symptoms,history of Vascular disease,Electrocardiography,Age,and Troponin(SVEAT)score has been shown to outperform the History,Electrocardiography,Age,Risk factors and Troponin(HEART)score,one of the most used risk scores in the United States.AIM To assess the potential usefulness of the SVEAT score as a risk stratification tool by comparing its performance to HEART score in chest pain patients with low suspicion for acute coronary syndrome and admitted for overnight observation.METHODS We retrospectively reviewed medical records of 330 consecutive patients admitted to our clinical decision unit for acute chest pain between January 1st to April 17th,2019.To avoid potential biases,investigators assigned to calculate the SVEAT,and HEART scores were blinded to the results of 30-d combined endpoint of death,acute myocardial infarction or confirmed coronary artery disease requiring revascularization or medical therapy[30-d major adverse cardiovascular event(MACE)].An area under receiving-operator characteristic curve(AUC)for each score was then calculated.C-statistic and logistic model were used to compare RESULTS A 30-d MACE was observed in 11 patients(3.33%of the subjects).The AUC of SVEAT score(0.8876,95%CI:0.82-0.96)was significantly higher than the AUC of HEART score(0.7962,95%CI:0.71-0.88),P=0.03.Using logistic model,SVEAT score with cut-off of 4 or less significantly predicts 30-d MACE(odd ratio 1.52,95%CI:1.19-1.95,P=0.001)but not the HEART score(odd ratio 1.29,95%CI:0.78-2.14,P=0.32).CONCLUSION The SVEAT score is superior to the HEART score as a risk stratification tool for acute chest pain in low to intermediate risk patients.

Electrocardiographic Analysis of Patients with Suspicion of Acute Coronary Syndrome in Yaounde, Cameroon

Background: Ischemic heart disease (IHD) is the leading cause of death worldwide. IHD was thought to be an extremely rare occurrence in Sub-Saharan Africa, but the increasing economic development with changes in lifestyle has led to an increase in IHD risk factors which has motivated the interest of our study. Objectives: The aim was to study a group of patients with suspicion of acute coronary syndrome (ACS), in order to determine those with and without electrocardiographic diagnosis of ACS. Methods: It was an observational cross-sectional descriptive study over a period of six months, which included concerned patients who presented with retrosternal or precordial chest pain of onset being less than two weeks with at least one cardiovascular risk factor, in the cardiology units of three reference hospitals in Yaounde. Ethical clearance and authorizations were obtained from the competent authorities. We used a preformed questionnaire to obtain information from the patients concerning the demographic data, clinical presentation and electrocardiographic findings. Results: We recruited 100 patients with suspicion of ACS. 56 patients presented with electrocardiographic diagnosis of ACS and 44 patients did not. The mean age was 60.6 ± 11.5 years with age limits of 32 - 85 years in patients with ACS and 55.3 ± 16.6 years with age limits of 19 - 90 years in patients without ACS. The predominant age group was 60 - 69 years in both groups. The sex ratio (male/female) was 0.6 in patients with ACS and 0.7 in patients without ACS. The main complaints presented in both groups were;chest pain, fatigue, dyspnea and palpitation. The frequent cardiovascular risk factors in both groups were hypertension, age and overweight/obesity. In patients with ACS, 55.4% presented with ST-segment elevated acute coronary syndrome (STE-ACS) and 44.6% presented with non-ST-segment elevated acute coronary syndrome (NSTE-ACS). The Antero-Septal territory represented 77.4% of patients with STE-ACS and the lateral territory represented 56.0% of patients with NSTE-ACS. Conclusion: This study shows that 56.0% of patients with suspicion of ACS had an electrocardiographic diagnosis of ACS. Further studies should be undertaken to determine the prevalence of ACS in our community.

规范化胸痛中心建设对和田地区急性冠状动脉综合征患者急诊经皮冠状动脉介入救治效率的影响

目的探讨在和田地区建设规范化胸痛中心对该地区急性冠状动脉综合征(ACS)患者接受急诊经皮冠状动脉介入(PCI)救治效率的影响。方法回顾性分析2021年1月至2022年4月在新疆维吾尔自治区和田地区人民医院就诊并确诊为ACS患者共445例,所有患者均接受急诊PCI治疗。其中规范化胸痛中心认证前通过急诊绿色通道模式(2021年1—8月)就诊的225例ACS患者纳入对照组;规范化胸痛中心认证通过后(2021年9月至2022年4月)就诊的220例ACS患者纳入观察组。比较2组患者的一般资料、院内主要不良心血管事件(MACE)发生率、其中确诊为ST段抬高型心肌梗死(STEMI)患者的再灌注救治效率指标以及住院天数、住院费用等情况。结果2组患者糖尿病史比例比较,差异有统计学意义(P<0.05)。2组患者院内心源性休克发生率比较,差异有统计学意义(P<0.05),观察组患者院内MACE总发生率明显低于对照组[10.9%(24/220)比17.8%(40/225)],差异有统计学意义(P=0.039)。规范化胸痛中心认证通过后的STEMI患者的发病至首次医疗接触时间、首次医疗接触至球囊扩张时间、入门至球囊扩张缺血时间、导管室激活时间均低于急诊绿色通道模式STEMI患者,差异均有统计学意义(均P<0.05)。观察组患者平均住院时间及平均住院费用均低于对照组[(7.7±2.1)d比(8.3±2.6)d、(28353±9071)元比(30163±10203)元],差异均有统计学意义(均P<0.05)。结论规范化胸痛中心建设可有效提高ACS患者院内救治效率,减少心肌缺血时间,降低患者MACE发生率,缩短住院时间,节省医疗费用。

Usefulness of PQRST pain assessment method for non-traumatic chest pain

Background The symptom of chest pain is one of the most common presenting complaints seen in primary and secondary care and is the leading cause of emergency department visits. PQRST pain assessment method might be useful, but contemporary researches of its feasibility for chest pain patients are limited. Methods Between March 2017 and August 2017, 533 consecutive patients as control group and 657 cases as treatment group were retrospectively recruited in the Emergency Department of our center. We compared the time took for the first cardiogram, the time spent in the emergency department, triage accuracy and patient stratification rate between two groups. Results In treatment group, statistically less time was spent to take the first cardiogram（5.3±1.2 vs. 11.2±2.5, P 〈 0.001）. This group had higher triage accuracy（92.34% vs. 86.91%, P = 0.003）and patient stratification（95.51% vs. 91.48%, P = 0.006）. Conclusions PQRST pain assessment method is useful and feasible for increasing triage accuracy and patient stratification rate of non-Traumatic chest pain patients in emergency department.

Chest pain and troponin elevation in a Duchenne Muscular Dystrophy:Acute myocardial infarction or progres-sion of Duchenne cardiomyopathy

Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is progressive, and ambulation is lost early in the second decade1. The main clinical features of the patients are the proximal muscle weakness and atrophy, unusual walking posture,

胸痛发作时床边即时检测心肌钙蛋白T诊断急性心肌梗死的价值

目的确定胸痛症状发作后不同时间间隔内,床边心肌肌钙蛋白T(point of care troponin-T testing,POCT-cTnT)对急性心肌梗死(acute myocardial infarction,AMI)的诊断性能,了解其在快速排除AMI方面的意义。方法这项回顾性研究包括了2019年1月至2022年12月期间出现胸痛症状的6024例患者。在入院时测量了POCT-cTnT和中心实验室cTnI水平。通过按时间窗口划分的受试者工作特征(receiver operating characteristics,ROC)分析,评估POCT-cTnT在诊断AMI时的准确性。结果总体而言,POCT-cTnT诊断AMI的AUC为0.826(95%CI:0.816~0.836),灵敏度和特异度分别为72.81%和86.26%。根据胸痛发作的时间进行区间分组(<3 h、3~6 h、6~12 h、12~24 h、24~72 h和≥72 h),6~12 h以后的分组AUC值分别为0.918、0.928、0.920和0.908,差异无统计学意义(P>0.05),均要高于6 h时以内的组(P<0.001);根据胸痛发作时间点进行分组,≥8 h组的AUC为0.921,阴性预测值(negative predictive value,NPV)98.1%和阴性似然比(negative likelihood ratio,-LR)0.11,其AUC高于≥3 h、≥2 h、≥1 h和overall组(P<0.05),而与≥4 h以后的各时间组相比,差异无统计学意义(P>0.05)。结论胸痛发作时间对单次检测POCT-cTnT诊断AMI的性能存在一定的影响,结合胸痛发作至就诊时间,可能提高其诊断或排除AMI的可靠性。在胸痛发作4 h后,单次POCT-cTnT检测能可靠地诊断或排除AMI;当胸痛发作8 h后,其诊断或排除AMI方面具有更高的可靠性。

胸痛中心区域协同救治体系建设对急性ST段抬高型心肌梗死救治的影响

目的:探讨胸痛中心区域协同救治体系建设对郑州地区急性ST段抬高型心肌梗死(STEMI)救治的影响。方法:选取郑州市中心医院胸痛中心2015年10月至2020年10月成立前、后收治的STEMI转诊患者,分别设为常规转诊组、区域协同转诊组,各90例。两组患者入院后均进行经皮冠状动脉介入术(PCI)治疗,比较两组患者发病后总缺血时间、从发病至首次医疗接触时间(S2FMC)、首次医疗接触到导丝通过时间(FMC2W),临床不良事件发生率的差异。结果:区域协同转诊组患者的总缺血时间、S2FMC、FMC2W均短于常规转诊组,差异具有统计学意义(P<0.05)。区域协同转诊组患者院内临床不良事件发生率低于常规转诊组,差异具有统计学意义(P<0.05)。结论:胸痛中心区域协同救治体系的建设,显著提高了STEMI转诊患者的临床救治效率,降低了院内临床不良事件发生率,有助于改善患者预后。

一键胸痛套餐包在急性胸痛诊断中的应用研究

目的 探讨一键胸痛套餐包在急性胸痛诊断中的应用价值。方法 以2022年5月—2023年4月通过一键胸痛套餐包为核心的胸痛全流程绿色通道重塑的急性胸痛患者为实验组(n=196),2021年5月至2022年4月通过原有的绿色通道流程入抢救室的急性胸痛患者为对照组(n=170),比较两组急性胸痛患者明确诊断所需时间,在急诊科抢救室滞留时间、出入院诊断符合率及患者与家属满意度。结果 与对照组相比,实验组急性胸痛诊断时间、抢救室滞留时间显著缩短,出入院诊断符合率明显提高,患者与家属满意度明显增加(P<0.001)。结论 一键胸痛套餐包为核心的胸痛全流程绿色通道,能够减少明确诊断所需时间,缩短在抢救室滞留时间,提高患者与家属满意度,减少医患矛盾。

急性胸痛患者早期风险评估研究进展

急性胸痛是急诊常见的症状之一,早期精准识别高风险性和低风险性胸痛有益于高危患者得到及时诊疗以及低危患者减少过度医疗,同时改善预后和缓解院前急救及急诊科医疗资源的严峻。近年来急性胸痛患者早期危险分层工具不断开发,其敏感度和特异度各有不同。本文对目前急性胸痛患者早期风险评估的研究进展进行综述。