Göğüs ağrısı olan hastalarda kararsız anjina pektorisi ayırt etmede end-tidal CO2'nin tanısal rolü

Year 2023, Volume: 3 Issue: 2, 29 - 36, 29.07.2023

Serhat Günlü , Ahmet Yeşil , Fethullah Kayan , Mehmet Zülkif Karahan

Abstract

Amaç: Akut koroner sendrom (AKS) türlerinden biri olan kararsız angina pektoris (UAP), kalp dışı göğüs ağrısından (non-CCP) ayırt edilmesi zordur, bu nedenle doğru tanı için çeşitli stratejiler uygulanır. Bu çalışma, kardiyovasküler öyküsü olmayan göğüs ağrısı ile acil servise (AS) başvuran hastalarda non-invaziv olarak ölçülen end-tidal CO2'nin (ETCO2) UAP'yi saptayıp saptayamayacağını incelemeyi amaçlamaktadır.
Yöntemler: Bu araştırma prospektif gözlemsel bir çalışma olarak yürütülmüştür. Bireyler, dahil etme ve hariç tutma kriterlerine göre iki gruba ayrıldı: CCP olmayan 75 hasta ve 75 UAP. Teşhis değeri kesimini tanımlamak için alıcı işletim özelliklerinin (ROC) analizlerinden yararlanılmıştır. Tek değişkenli regresyon analizi kullanılarak, UAP tahmini için ETCO2'nin olasılık oranı (%95 CI ile) hesaplandı.
Bulgular: Araştırma popülasyonunun yaş ortalaması 61.2±11.3 olup, 34'ü kadın (%22.7), 116'sı erkektir (%77,3). Klinik özellikler ve laboratuvar parametreleri açısından gruplar arasında önemli farklılıklar yoktu. ETCO2 seviyeleri UAP grubunda CCP olmayan grupla karşılaştırıldığında önemli ölçüde daha düşüktü (p<0.001). ROC eğrisinin analizi, %78 duyarlılık ve %89 özgüllükle (EAA:0.81, p <0.001) azalmış bir ETCO2 <35'in UAP'yi öngördüğünü ortaya koydu. Ayrıca negatif prediktif değer %71.6, pozitif prediktif değer ise %79.4 olarak bulundu. UAP'li hastaların ETCO2 <35'e sahip olma olasılığı ÇKP olmayan hastalara göre 8.84 kat daha fazlaydı.
Sonuç: UAP, göğüs ağrısı olan hastalarda non-invaziv bir parametre olarak ölçülen ETCO2 ile CCP olmayandan ayırt edilebilir.

Keywords

kararsız anjina, soluk sonu karbondioksit, kalp dışı göğüs ağrısı, akut koroner sendrom, koroner bakım ünitesi

The diagnostic role of end-tidal CO2 to distinguish unstable angina pectoris in patients with chest pain

Abstract

Objective: Unstable angina pectoris (UAP), one of the acute coronary syndrome (ACS) types, is difficult to identify from non-cardiac chest pain (non-CCP), hence various strategies are applied for accurate diagnosis. This study aims to examine whether non-invasively measured end-tidal CO2 (ETCO2) can detect UAP in patients admitted to the emergency department (ED) with chest pain in the lack of a cardiovascular history.
Methods: This research was conducted as a prospective observational study. The individuals were separated into two groups based on the inclusion and exclusion criteria: 75 patients with non-CCP and 75 UAP. Analyses of receiver operating characteristics (ROC) were utilized to define the diagnostic value cutoff. Using univariate regression analysis, the odds ratio of ETCO2 (with 95%CI) was computed for UAP prediction.
Results: The mean age of the research population was 61.2±11.3 years, with 34 females (22.7%) and, 116 males (77.3%). There were no substantial differences across the groups regarding clinical characteristics and laboratory parameters. ETCO2 levels were substantially lower in the UAP group compared with the non-CCP group (p<0.001). Analysis of the ROC curve revealed that a decreased ETCO2 <35 predicted UAP with 78% sensitivity and 89% specificity (AUC:0.81, p <0.001). In addition, the negative predictive value was 71.6%, and the positive predictive value was 79.4%. Patients with UAP were 8.84 times more likely to have ETCO2 <35 than patients with non-CCP.
Conclusion: UAP may be differentiated from non-CCP by ETCO2 measured as a non-invasive parameter in patients with chest pain.

Keywords

end-tidal carbon dioxide, non-cardiac chest pain, acute coronary syndrome, coronary care unit, unstable angina

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