- Klíčová slova
- triage, urgentní příjem, implementace systému triage,
- MeSH
- časové faktory MeSH
- lidé MeSH
- třídění pacientů klasifikace statistika a číselné údaje MeSH
- urgentní služby nemocnice * organizace a řízení využití MeSH
- zlepšení kvality MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
This study was designed to determine the usefulness of coronary computed tomography angiography (CTA) in patients with acute chest pain. BACKGROUND: Triage of chest pain patients in the emergency department remains challenging. METHODS: We used an observational cohort study in chest pain patients with normal initial troponin and nonischemic electrocardiogram. A 64-slice coronary CTA was performed before admission to detect coronary plaque and stenosis (>50% luminal narrowing). Results were not disclosed. End points were acute coronary syndrome (ACS) during index hospitalization and major adverse cardiac events during 6-month follow-up. RESULTS: Among 368 patients (mean age 53 +/- 12 years, 61% men), 31 had ACS (8%). By coronary CTA, 50% of these patients were free of coronary artery disease (CAD), 31% had nonobstructive disease, and 19% had inconclusive or positive computed tomography for significant stenosis. Sensitivity and negative predictive value for ACS were 100% (n = 183 of 368; 95% confidence interval [CI]: 98% to 100%) and 100% (95% CI: 89% to 100%), respectively, with the absence of CAD and 77% (95% CI: 59% to 90%) and 98% (n = 300 of 368, 95% CI: 95% to 99%), respectively, with significant stenosis by coronary CTA. Specificity of presence of plaque and stenosis for ACS were 54% (95% CI: 49% to 60%) and 87% (95% CI: 83% to 90%), respectively. Only 1 ACS occurred in the absence of calcified plaque. Both the extent of coronary plaque and presence of stenosis predicted ACS independently and incrementally to Thrombolysis In Myocardial Infarction risk score (area under curve: 0.88, 0.82, vs. 0.63, respectively; all p < 0.0001). CONCLUSIONS: Fifty percent of patients with acute chest pain and low to intermediate likelihood of ACS were free of CAD by computed tomography and had no ACS. Given the large number of such patients, early coronary CTA may significantly improve patient management in the emergency department.
- MeSH
- akutní koronární syndrom diagnóza patofyziologie MeSH
- akutní nemoc MeSH
- bolesti na hrudi diagnóza patofyziologie MeSH
- časové faktory MeSH
- diferenciální diagnóza MeSH
- financování organizované MeSH
- interval spolehlivosti MeSH
- jednoduchá slepá metoda MeSH
- koronární angiografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- odds ratio MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- ROC křivka MeSH
- senzitivita a specificita MeSH
- tomografy rentgenové počítačové MeSH
- třídění pacientů statistika a číselné údaje MeSH
- urgentní služby nemocnice statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Kalifornie MeSH
