Noninvasive Cardiac Testing and Cardiovascular Outcomes for Low-Risk Chest Pain in the Emergency Department: A Systematic Review and Meta-Analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-10-01 DOI:10.1016/j.cjco.2024.06.009
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Abstract

Background

With the widespread adoption of high-sensitivity troponin testing, recent guidelines no longer recommend urgent noninvasive cardiac testing for suspected cardiac disease in low-risk emergency department (ED) patients. We conducted a meta-analysis to determine whether urgent noninvasive testing, compared to no testing, is associated with improved cardiovascular outcomes in low-risk patients.

Methods

We searched databases for studies of adults evaluated in the ED for low-risk acute chest pain based on clinical criteria, diagnostic testing, or risk scores. Outcomes were all-cause death or myocardial infarction (MI), and revascularization alone, at 90 days and 1 year.

Results

A total of 1.5 million patients were included from 17 observational and 2 randomized studies. The overall rate of death or MI was 0.3% at 90 days, and 0.4% at 1 year. The odds of death or MI were not significantly different at 90 days (9 studies with 144,447 participants; odds ratio [OR] = 0.92 [0.48-1.76]) or 1 year (13 studies with 146,563 participants; OR = 0.92 [0.63-1.35]) between the tested and nontested groups. The odds of revascularization were significantly higher in tested groups at 90 days (12 studies with 513,862 participants; OR = 2.21 [1.17-4.17]) and 1 year (16 studies with 1,441,693 participants; OR = 2.61 [1.95-3.48]).

Conclusions

Noninvasive testing for low-risk chest pain in the ED was not associated with lower odds of death or MI, but it was associated with more than twice the odds of revascularization. This finding supports current guidelines recommending against universal noninvasive testing for ED patients with low-risk chest pain.
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急诊科低风险胸痛的无创心脏检测和心血管预后:系统回顾和荟萃分析
背景随着高敏肌钙蛋白检测的广泛采用,最近的指南不再建议对急诊科(ED)低风险患者的疑似心脏病进行紧急无创心脏检测。我们进行了一项荟萃分析,以确定与不进行检测相比,紧急无创检测是否与低风险患者心血管预后的改善有关。方法我们在数据库中搜索了根据临床标准、诊断性检测或风险评分对急诊科低风险急性胸痛成人进行评估的研究。结果共纳入了 17 项观察性研究和 2 项随机研究中的 150 万名患者。90天内死亡或心肌梗死的总发生率为0.3%,1年后为0.4%。在 90 天(9 项研究,144447 名参与者;几率比 [OR] = 0.92 [0.48-1.76])或 1 年(13 项研究,146563 名参与者;OR = 0.92 [0.63-1.35])时,接受测试组和未接受测试组的死亡或心肌梗死几率没有显著差异。在 90 天(12 项研究,513,862 名参与者;OR = 2.21 [1.17-4.17])和 1 年(16 项研究,1,441,693 名参与者;OR = 2.61 [1.95-3.48])时,检测组的血管再通几率明显更高。这一发现支持当前指南的建议,即不要对急诊室低风险胸痛患者进行普遍的无创检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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