Abstract：
With the current high burden on the healthcare system and limited resources, the efficient utilization of facilities is of utmost importance. We sought to present the practice guideline used at a high prevalence tertiary cardiology center and compare its safety and efficacy performance with the single high-sensitivity cardiac troponin T strategy, conventional and modified HEART score.
In this prospective cohort study, consecutive patients presenting to the emergency department with chest pain or an angina equivalent were recruited. The primary endpoints consisted of major adverse cardiac events at index visits and 30-day follow-up. Patients were managed according to the practice guideline, and sensitivity and negative predictive values were compared.
Of the total 1548 patients, the mean age was 50.4 ± 15.7 years. Ninety-nine (10.9%) patients were admitted at the index visit, and 89 patients were consequently diagnosed with acute coronary symptoms. Six (0.007%) patients experienced major adverse cardiac events within the 30-day follow-up among discharged patients. Among 911 patients with at least 1 troponin, using single high-sensitivity cardiac troponin T, HEART score, and modified HEART score would have further admitted 805, 450, and 609 patients, respectively. The negative predictive value for all 4 algorithms did not significantly differ (99.2% vs. 100% vs. 99.3% vs. 99.6%, respectively).
The Tehran Herat Center protocol was a relatively safe protocol with high efficacy. Despite the high safety of the other diagnostic pathways, the high volume of patients needing additional evaluation could impose a high burden on the health care system.
In this prospective cohort study, consecutive patients presenting to the emergency department with chest pain or an angina equivalent were recruited. The primary endpoints consisted of major adverse cardiac events at index visits and 30-day follow-up. Patients were managed according to the practice guideline, and sensitivity and negative predictive values were compared.
Of the total 1548 patients, the mean age was 50.4 ± 15.7 years. Ninety-nine (10.9%) patients were admitted at the index visit, and 89 patients were consequently diagnosed with acute coronary symptoms. Six (0.007%) patients experienced major adverse cardiac events within the 30-day follow-up among discharged patients. Among 911 patients with at least 1 troponin, using single high-sensitivity cardiac troponin T, HEART score, and modified HEART score would have further admitted 805, 450, and 609 patients, respectively. The negative predictive value for all 4 algorithms did not significantly differ (99.2% vs. 100% vs. 99.3% vs. 99.6%, respectively).
The Tehran Herat Center protocol was a relatively safe protocol with high efficacy. Despite the high safety of the other diagnostic pathways, the high volume of patients needing additional evaluation could impose a high burden on the health care system.
摘要：
由于目前医疗保健系统的负担很高，资源有限，设施的有效利用至关重要。我们试图提出在高患病率三级心脏病中心使用的实践指南，并将其安全性和有效性与单一高敏心肌肌钙蛋白T策略进行比较。常规和改良的心脏评分。
在这项前瞻性队列研究中，我们招募了连续到急诊科就诊的胸痛或心绞痛患者.主要终点包括初次访视和30天随访时的主要不良心脏事件。根据实践指南对患者进行管理，比较敏感性和阴性预测值。
在总共1548名患者中,平均年龄为50.4±15.7岁。九十九名(10.9%)病人在索引访视时入院,89例患者因此被诊断为急性冠状动脉症状。在出院患者中，有6例（0.007％）患者在30天的随访中出现了主要的不良心脏事件。在911名至少有1个肌钙蛋白的患者中，使用单一的高敏心肌肌钙蛋白T，心脏得分，和改良的心脏评分将进一步收治805、450和609名患者，分别。所有4种算法的阴性预测值没有显着差异(99.2%与100%vs.99.3%vs.99.6%,分别)。
德黑兰赫拉特中心方案是一个相对安全的方案，具有很高的疗效。尽管其他诊断途径的安全性很高，大量需要额外评估的患者可能会给医疗保健系统带来沉重的负担。
在这项前瞻性队列研究中，我们招募了连续到急诊科就诊的胸痛或心绞痛患者.主要终点包括初次访视和30天随访时的主要不良心脏事件。根据实践指南对患者进行管理，比较敏感性和阴性预测值。
在总共1548名患者中,平均年龄为50.4±15.7岁。九十九名(10.9%)病人在索引访视时入院,89例患者因此被诊断为急性冠状动脉症状。在出院患者中，有6例（0.007％）患者在30天的随访中出现了主要的不良心脏事件。在911名至少有1个肌钙蛋白的患者中，使用单一的高敏心肌肌钙蛋白T，心脏得分，和改良的心脏评分将进一步收治805、450和609名患者，分别。所有4种算法的阴性预测值没有显着差异(99.2%与100%vs.99.3%vs.99.6%,分别)。
德黑兰赫拉特中心方案是一个相对安全的方案，具有很高的疗效。尽管其他诊断途径的安全性很高，大量需要额外评估的患者可能会给医疗保健系统带来沉重的负担。
