Early Rule-Out and Rule-In Strategies for Myocardia Infarction

被引:35
作者
Cullen, Louise A. [1 ]
Mills, Nicholas L. [2 ]
Mahler, Simon [3 ]
Body, Richard [4 ]
机构
[1] Royal Brisbane & Womens Hosp, Butterfield St, Brisbane, Qld 4029, Australia
[2] Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
[3] Wake Forest Sch Med, Winston Salem, NC USA
[4] Cent Manchester Univ Hosp NHS Fdn Trust, Manchester, Lancs, England
关键词
ACUTE CORONARY SYNDROME; SENSITIVITY CARDIAC TROPONIN; ACID-BINDING PROTEIN; ACCELERATED DIAGNOSTIC PROTOCOL; EMERGENCY-DEPARTMENT PATIENTS; CHEST-PAIN PATIENTS; TIMI RISK SCORE; RANDOMIZED CONTROLLED-TRIAL; MARKERS RATPAC TRIAL; EXTERNAL VALIDATION;
D O I
10.1373/clinchem.2016.254730
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
BACKGROUND: Patients with chest pain comprise a large proportion of emergency presentations and place a major, burden on healthcare resources. Therefore, efforts to safely and rapidly identify those with and without acute myocardial infarction (AMI) are needed. The challenge for clinicians is to accurately identify patients with acute coronary syndromes, while balancing the need to safely and rapidly reassure and discharge those without serious conditions. CONTENT: This review summarizes the evidence to date on optimum accelerated strategies for the rule-in and rule-out of AMI, using strategies focused on optimum use of troponin results. Evidence based on both sensitive and highly sensitive troponin assay results is presented. The use of novel biomarkers is also addressed and the combination of biomarkers with other clinical information in accelerated diagnostic strategies is discussed. SUMMARY: The majority of patients, who are not at risk of myocardial infarction or other serious harm, may be suitable for discharge directly from the emergency setting using approaches focused on troponin algorithms and accelerated diagnostic protocols. Evidence about the clinical and health economic impact of use of such strategies is needed, as they may have major benefits for both patients and healthcare providers. (C) 2016 American Association for Clinical Chemistry
引用
收藏
页码:129 / 139
页数:11
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