Prognostic utility of a modified HEART score in chest pain patients in the emergency department

• Verfasst von: McCord, James [VerfasserIn]
• Verfasst von: Cabrera, Rafael [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Prognostic utility of a modified HEART score in chest pain patients in the emergency department
• Verf.angabe: McCord James, Cabrera Rafael, Lindahl Bertil, Giannitsis Evangelos, Evans Kaleigh, Nowak Richard, Frisoli Tiberio, Body Richard, Christ Michael, deFilippi Christopher R., Christenson Robert H., Jacobsen Gordon, Alquezar Aitor, Panteghini Mauro, Melki Dina, Plebani Mario, Verschuren Franck, French John, Bendig Garnet, Weiser Silvia, Mueller Christian, null null, Twerenbold Raphael, Katus Hugo A., Popp Steffen, Ordóñez-Llanos Jorge, Santalo-Bel Miquel, Horner Daniel, Dolci Alberto, Jernberg Tomas, Zaninotto Martina, Manara Alessandro, Dinkel Carina, Menassanch-Volker Sylvie, Jarausch Jochen, Zaugg Christian
• E-Jahr: 2017
• Jahr: 6 February 2017
• Umfang: 8 S.
• Fussnoten: Gesehen am 14.11.2018
• Titel Quelle: Enthalten in: Circulation / Cardiovascular quality and outcomes
• Ort Quelle: Philadelphia, Pa. : Lippincott, Williams & Wilkins, 2008
• Jahr Quelle: 2017
• Band/Heft Quelle: 10(2017), 2, Artikel-ID e003101
• ISSN Quelle: 1941-7705
• DOI: doi:10.1161/CIRCOUTCOMES.116.003101
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1583704787

Abstract

Background—The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial.Methods and Results—Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03).Conclusions—Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.