Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Open Heart Pub Date : 2024-08-03 DOI:10.1136/openhrt-2024-002755

Daniel Perez-Vicencio, Alexander J F Thurston, Dimitrios Doudesis, Rachel O'Brien, Amy Ferry, Takeshi Fujisawa, Michelle Claire Williams, Alasdair J Gray, Nicholas L Mills, Kuan Ken Lee

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Abstract

Background: Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain.

Methods: In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to sex-specific 99th percentile) in whom myocardial infarction was ruled out were enrolled and underwent coronary CT angiography (CCTA) after hospital discharge. History, ECG, Age, Risk factors, Troponin (HEART), Emergency Department Assessment of Chest Pain Score (EDACS), Global Registry of Acute Coronary Event (GRACE), Thrombolysis In Myocardial Infarction (TIMI), Systematic COronary Risk Evaluation 2 and Pooled Cohort Equation risk scores were calculated and the odds ratio (OR) and diagnostic performance for obstructive coronary artery disease were determined using established thresholds.

Results: Of 167 patients enrolled (64±12 years, 28% female), 29.9% (50/167) had obstructive coronary artery disease. The odds of having obstructive disease were increased for all scores with the lowest and highest increase observed for an EDACS score ≥16 (OR 2.2 (1.1-4.6)) and a TIMI risk score ≥1 (OR 12.9 (3.0-56.0)), respectively. The positive predictive value (PPV) was low for all scores but was highest for a GRACE score >88 identifying 39% as high risk with a PPV of 41.9% (30.4-54.2%). The negative predictive value (NPV) varied from 77.3% to 95.2% but was highest for a TIMI score of 0 identifying 26% as low risk with an NPV of 95.2% (87.2-100%).

Conclusions: In patients with intermediate cardiac troponin concentrations in whom myocardial infarction has been excluded, clinical risk scores can help identify patients with and without coronary artery disease, although the performance of established risk thresholds is suboptimal for utilisation in clinical practice.

Trial registration number: NCT04549805.

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疑似急性冠状动脉综合征患者的风险评分和冠状动脉疾病，以及心肌肌钙蛋白中间浓度。

背景：指南建议在排除心肌梗死后使用风险评分来选择接受进一步检查的患者，但这些评分对识别冠状动脉疾病患者的作用并不确定：指南建议在排除心肌梗死后使用风险评分来选择接受进一步检查的患者，但其在识别冠状动脉疾病患者方面的作用尚不确定：在一项前瞻性队列研究中，研究人员招募了高敏心肌肌钙蛋白I浓度处于中等水平（5纳克/升至性别特异性第99百分位数）且心肌梗死已被排除的患者，并在出院后对其进行了冠状动脉CT血管造影（CCTA）检查。计算病史、心电图、年龄、危险因素、肌钙蛋白（HEART）、急诊科胸痛评估评分（EDACS）、全球急性冠状动脉事件登记（GRACE）、心肌梗死溶栓治疗（TIMI）、系统性冠状动脉风险评估 2（Systematic COronary Risk Evaluation 2）和汇集队列方程（Pooled Cohort Equation）风险评分，并使用既定阈值确定阻塞性冠状动脉疾病的几率比（OR）和诊断性能：在 167 名入选患者（64±12 岁，28% 为女性）中，29.9%（50/167）患有阻塞性冠状动脉疾病。在所有评分中，患有阻塞性疾病的几率均有所增加，其中 EDACS 评分≥16（OR 2.2 (1.1-4.6)）和 TIMI 风险评分≥1（OR 12.9 (3.0-56.0)）的几率增幅分别最低和最高。所有评分的阳性预测值（PPV）都很低，但 GRACE 评分大于 88 分的阳性预测值最高，PPV 为 41.9% (30.4-54.2%)，将 39% 的人确定为高风险。阴性预测值（NPV）从 77.3% 到 95.2% 不等，但 TIMI 评分为 0 的预测值最高，26% 的患者被认定为低风险，NPV 为 95.2% (87.2-100%)：结论：对于心肌肌钙蛋白浓度处于中等水平且已排除心肌梗死的患者，临床风险评分可帮助识别有无冠状动脉疾病的患者，但已建立的风险阈值在临床实践中的应用效果并不理想：NCT04549805。

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

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.