Acil serviste akut koroner sendrom karar yardımcılarının karşılaştırılması

Year 2024, Volume: 49 Issue: 4, 1030 - 1043, 30.12.2024

Mehmet Seyfettin Sarıbaş , Atakan Savrun , Ali Aygun , Şeyda Tuba Savrun

https://doi.org/10.17826/cumj.1493062

Abstract

Amaç: Bu çalışma, Emergency Department Assessment of Chest Pain Score (EDACS), History, Electrocardiography, Age, Risk Factors, Troponin (HEART) ve Thrombolysis in Myocardial Infarction (TIMI) skorlarının düşük riskli akut koroner sendrom (AKS), hastalarını belirleme ve 30 günlük majör istenmeyen kardiyak olayları (MİKO) öngörme performanslarını karşılaştırmayı amaçlamıştır.
Gereç ve Yöntem: Bu prospektif çalışmaya, travmatik olmayan göğüs ağrısı ile AS’ye başvuran ve AKS açısından değerlendirilen 18 yaş ve üzeri hastalar dahil edilmiştir. HEART, TIMI, EDACS ve EDACS-ADP skorları hesaplanmıştır. Miyokard enfarktüsü, acil revaskülarizasyon veya ölüm MİKO olarak tanımlanmış ve telefonla takip yoluyla doğrulanmıştır. Tanısal performans, eğri altındaki alan (EAA) analizleri ile değerlendirilmiştir.
Bulgular: Çalışmaya 408 hasta dahil edilmiş ve 64’ünde (%15.7) MİKO gelişmiştir. En yüksek EAA değeri HEART skoruna (0,823) aitken, bunu TIMI (0,784), EDACS-ADP (0,769) ve EDACS (0,716) takip etmiştir. HEART, en yüksek duyarlılık (%90,6) ve negatif prediktif değer (NPD, %97,2) göstermiştir. TIMI’nin ≤1 kesim değerinde duyarlılık %81,3 ve NPD %94,7 iken, kesim değerinin <1’e düşürülmesi duyarlılığı %96,8 ve NPD’yi %98,8’e çıkarmıştır. EDACS, %56,2 duyarlılık ve %90,3 NPD gösterirken, EDACS-ADP %82,8 duyarlılık ve %95,7 NPD göstermiştir.
Sonuç: HEART skoru, 30 günlük MİKO’yu öngörmede TIMI, EDACS ve EDACS-ADP’den üstün performans göstermiş, en iyi duyarlılık ve NPD’ye sahip olmuştur. TIMI kesim değerinin ayarlanması tanısal performansı artırabilir, ancak AS'de kalış süresini uzatabilir. HEART skoru, düşük riskli AKS hastalarını belirlemek ve güvenli taburculuk kararlarını desteklemek için en güvenilir araçtır.

Keywords

Akut koroner sendrom, EDACS, HEART, Göğüs ağrısı, MİKO, TIMI

Ethical Statement

Study approval was obtained from the clinical ethics committee of Ordu University Faculty of Medicine. Ethics Committee Decision Date: 23.09.2021. Decision Number: 2021/211.

Supporting Institution

The authors received no financial support for the research, authorship and/or publication of this article.

Thanks

None.

Comparison of acute coronary syndrome decision aids in the emergency department

Abstract

Purpose: This study compared the performance of the Emergency Department Assessment of Chest Pain Score (EDACS), History, Electrocardiography, Age, Risk Factors, Troponin (HEART), and Thrombolysis in Myocardial Infarction (TIMI) in identifying low-risk acute coronary syndrome (ACS) patients and predicting 30-day major adverse cardiac events (MACE).
Materials and Methods: This prospective study included patients aged ≥18 years with nontraumatic chest pain evaluated for ACS. HEART, TIMI, EDACS, and EDACS-ADP scores were calculated. MACE, including myocardial infarction, urgent revascularization, or death, was determined via telephone follow-up. Diagnostic performance was assessed using area under the curve (AUC) analysis.
Results: Among 408 patients, 64 (15.7%) developed MACE. The HEART score had the highest AUC (0.823), followed by TIMI (0.784), EDACS-ADP (0.769), and EDACS (0.716). HEART had the highest sensitivity (90.6%) and negative predictive value (NPV; 97.2%). TIMI, at a ≤1 cut-off, had sensitivity of 81.3% and NPV of 94.7%; reducing the cut-off to <1 increased sensitivity to 96.8% and NPV to 98.8%. EDACS showed sensitivity of 56.2% and NPV of 90.3%, whereas EDACS-ADP had sensitivity of 82.8% and NPV of 95.7%.
Conclusion: The HEART score outperformed TIMI, EDACS, and EDACS-ADP in predicting 30-day MACE, with superior sensitivity and NPV. Adjusting the TIMI cut-off enhances diagnostic performance but may increase ED stay. The HEART score is the most reliable tool for identifying low-risk patients with ACS and enabling safe discharge.

Keywords

Acute Coronary Syndrome, Chest pain, EDACS, HEART, MACE, TIMI

Ethical Statement

Study approval was obtained from the clinical ethics committee of Ordu University Faculty of Medicine. Ethics Committee Decision Date: 23.09.2021. Decision Number: 2021/211

Supporting Institution

All authors received no financial support for the research, authorship and/or publication of this article.

Thanks

None.

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