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Classification performance of clinical risk scoring in suspected acute coronary syndrome beyond a rule-out troponin profile
European Heart Journal - Acute Cardiovascular Care ( IF 4.1 ) Pub Date : 2021-05-22 , DOI: 10.1093/ehjacc/zuab040
Ehsan Khan 1, 2 , Kristina Lambrakis 1, 2 , Andrew Blyth 1, 2 , Anil Seshadri 1, 2 , Michael J R Edmonds 2 , Tom Briffa 3 , Louise A Cullen 4, 5, 6 , Stephen Quinn 7, 8 , Matthew Horsfall 1, 2 , Erin Morton 1 , John K French 9 , Cynthia Papendick 3 , Adam J Nelson 2, 10, 11 , Derek P Chew 1, 2, 3
Affiliation  

Aims High-sensitivity cardiac troponin strategies can provide risk stratification in patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). This study evaluated whether clinical risk scoring improves the classification performance of a rule-out profile in suspected ACS. Methods and results Patients presenting to ED with suspected ACS as part of the RAPID-TnT trial randomized to the intervention arm were included. Results ≥5 ng/L were available for all participants in this analysis. We evaluated the Thrombolysis In Myocardial Infarction (TIMI) risk score, History ECG Age Risk factors Troponin (HEART) score, and Emergency Department Assessment of Chest pain Score (EDACS) in addition to a rule-out profile based on the 0/1-h high-sensitivity cardiac troponin T protocol (<5 ng/L or ≤12 ng/L and a change of <3 ng/L at 1-h) using test performance parameters focusing on low-risk groups to identify the primary endpoint (TIMI ≤ 1, HEART ≤ 3, EDACS < 16). Primary endpoint was a composite of type 1/2 myocardial infarction (MI) at index presentation and all-cause mortality or type 1/2 MI at 30 days. A total of 3378 participants were enrolled between August 2015 and April 2019 of which 108 were ineligible/withdrew consent (intervention arm: n = 1638). Sensitivity, specificity, negative predictive value (NPV), and area under the curve (AUC) of the rule-out profile was 94.4%, 76.8%, 99.6%, and 0.86, respectively with 72.9% identified as ‘low-risk’. Adding the clinical risk scores did not improve the sensitivity, NPV, or AUC with significantly lower specificity and ‘low-risk’ classified participants. Conclusions Addition of clinical risk scores to rule-out profile did not demonstrate improved classification performance for identifying the composite of type 1/2 MI at index presentation and all-cause mortality or type 1/2 MI at 30 days. Clinical trials registration URL: https://www.anzctr.org.au. Reg. No. ACTRN12615001379505.

中文翻译:

排除肌钙蛋白谱后疑似急性冠状动脉综合征临床风险评分的分类性能

目标 高灵敏度心肌肌钙蛋白策略可以为急诊科 (ED) 疑似急性冠状动脉综合征 (ACS) 患者提供风险分层。本研究评估了临床风险评分是否能提高疑似 ACS 排除特征的分类性能。方法和结果 随机分配到干预组的 RAPID-TnT 试验中疑似 ACS 的 ED 患者被纳入研究。结果≥5 ng/L 可用于该分析的所有参与者。除了基于 0/1- h 高灵敏度心肌肌钙蛋白 T 方案(<5 ng/L 或 ≤12 ng/L 并且 & lt;3 ng/L at 1-h) 使用专注于低风险组的测试性能参数来确定主要终点 (TIMI ≤ 1, HEART ≤ 3, EDACS < 16)。主要终点是指数表现时的 1/2 型心肌梗死 (MI) 和 30 天时的全因死亡率或 1/2 型心肌梗死的复合终点。2015 年 8 月至 2019 年 4 月期间共有 3378 名参与者入组,其中 108 名不符合条件/撤回同意(干预组:n = 1638)。排除概况的敏感性、特异性、阴性预测值 (NPV) 和曲线下面积 (AUC) 分别为 94.4%、76.8%、99.6% 和 0.86,其中 72.9% 被确定为“低风险”。添加临床风险评分并没有提高敏感性、NPV 或 AUC,具有显着降低的特异性和“低风险”分类的参与者。结论 将临床风险评分添加到排除概况中并没有证明在识别指数呈现时的 1/2 型 MI 和 30 天时的全因死亡率或 1/2 型 MI 的复合物方面的分类性能有所改善。临床试验注册网址:https://www.anzctr.org.au。注册。编号 ACTRN12615001379505。
更新日期:2021-05-22
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