Purpose of Review

As many as 10 million patients present annually to the emergency department in the USA with symptoms concerning for acute myocardial infarction. The use of risk scores for patients with chest pain or equivalent without ST-segment elevation on the electrocardiogram. The adaptation in the USA of high sensitivity troponin assays requires rethinking of how to best optimize troponin testing within a risk score.

Recent Findings

Patients are risk stratified using a combination of validated risk scores, biomarkers, and both noninvasive and invasive testing. The advent of high-sensitivity troponins has served to augment existing risk scores in the identification of low-risk patients for early discharge, as well as led to the introduction of new rapid rule-out protocols by which acute myocardial infarction can be excluded by biomarker evaluation more quickly. The emergence of machine learning algorithms may further enhance provider’s ability to quickly diagnose or exclude myocardial infarction in the emergency department.

Summary

The addition of high sensitive troponin assays to established emergency department risk scores is providing new opportunities to improve the timeliness and accuracy of the evaluation of patients presenting with a possible myocardial infarction. Utilizing the time between troponin measures as a variable combined with clinical risk factors with new algorithms may further serve to improve diagnostic accuracy.

中文翻译：

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急诊科的胸痛评估：风险评分和高敏感性心肌肌钙蛋白。

审查目的

每年有多达1000万患者出现在美国急诊科，并伴有急性心肌梗死的症状。心电图上有胸痛或类似症状但无ST段抬高的患者使用风险评分。在美国，适应性高的肌钙蛋白检测方法需要重新考虑如何在风险评分内最佳地优化肌钙蛋白检测。

最近的发现

使用经过验证的风险评分，生物标记以及非侵入式和侵入式测试的组合来对患者进行风险分层。高敏感性肌钙蛋白的出现有助于增加现有风险评分，以识别出早期出院的低风险患者，并导致引入新的快速排除方案，从而通过生物标志物排除急性心肌梗塞评估更快。机器学习算法的出现可以进一步提高服务提供者在急诊室快速诊断或排除心肌梗塞的能力。

概要

将高敏感性肌钙蛋白测定法添加到已建立的急诊室风险评分中，为改善对可能患有心肌梗塞的患者进行评估的及时性和准确性提供了新的机会。利用肌钙蛋白措施之间的时间作为变量与新的算法结合临床危险因素，可以进一步提高诊断准确性。