PDF(Pubmed)
Abstract：
UNASSIGNED: For patients with acute myocardial infarction (AMI), direct coronary angiography (CA) is recommended, while for non-AMI patients, the diagnostic work-up depends on clinical criteria. This analysis provides initial prospective German data for the degree of guideline-adherence (GL) in the use of CA on non-AMI patients presenting at the emergency department (ED) with suspected acute coronary syndrome (ACS) according to the 2015 ESC-ACS-GL. Furthermore the implications of the application of the 2020 ESC-ACS-GL recommendations were evaluated.
UNASSIGNED: Patient symptoms were identified using a standardized questionnaire; medical history and diagnostic work-up were acquired from health records. In accordance with the 2015 ESC-ACS-GL, CA was considered GL-adherent if intermediate risk criteria (IRC) were present or non-invasive, image-guided testing (NIGT) was pathological.
UNASSIGNED: Between January 2019 and August 2021, 229 patients were recruited across seven centers. Patients presented with chest pain, dyspnea, and other symptoms in 66.7%, 16.2% and 17.1%, respectively, were in mean 66.3 ± 10.5 years old, and 36.3% were female. In accordance with the 2015 ESC-ACS-GL, the use of CA was GL-adherent for 64.0% of the patients. GL-adherent compared to non-adherent use of CA resulted in revascularization more often (44.5% vs. 17.1%, p < 0.001). Applying the 2020 ESC-ACS-GL, 20.4% of CA would remain GL-adherent.
UNASSIGNED: In the majority of cases, the use of CA was adherent to the 2015 ESC-ACS-GL. With regard to the 2020 and 2023 ESC-ACS-GL, efforts to expand the utilization of NIGT are crucial, especially as GL-adherent use of CA is more likely to result in revascularization.(German Clinical Trials Register DRKS00015638; https://drks.de/search/de/trial/DRKS00015638; (registration date: 19 February 2019)).
UNASSIGNED: Patient symptoms were identified using a standardized questionnaire; medical history and diagnostic work-up were acquired from health records. In accordance with the 2015 ESC-ACS-GL, CA was considered GL-adherent if intermediate risk criteria (IRC) were present or non-invasive, image-guided testing (NIGT) was pathological.
UNASSIGNED: Between January 2019 and August 2021, 229 patients were recruited across seven centers. Patients presented with chest pain, dyspnea, and other symptoms in 66.7%, 16.2% and 17.1%, respectively, were in mean 66.3 ± 10.5 years old, and 36.3% were female. In accordance with the 2015 ESC-ACS-GL, the use of CA was GL-adherent for 64.0% of the patients. GL-adherent compared to non-adherent use of CA resulted in revascularization more often (44.5% vs. 17.1%, p < 0.001). Applying the 2020 ESC-ACS-GL, 20.4% of CA would remain GL-adherent.
UNASSIGNED: In the majority of cases, the use of CA was adherent to the 2015 ESC-ACS-GL. With regard to the 2020 and 2023 ESC-ACS-GL, efforts to expand the utilization of NIGT are crucial, especially as GL-adherent use of CA is more likely to result in revascularization.(German Clinical Trials Register DRKS00015638; https://drks.de/search/de/trial/DRKS00015638; (registration date: 19 February 2019)).
摘要：
■对于急性心肌梗死（AMI）患者，建议直接冠状动脉造影(CA),而对于非AMI患者，诊断工作取决于临床标准.根据2015年ESC-ACS-GL，该分析为在急诊科（ED）出现疑似急性冠状动脉综合征（ACS）的非AMI患者使用CA的指南依从性（GL）提供了初步的德国前瞻性数据。此外，还评估了应用2020年ESC-ACS-GL建议的含义。
■使用标准化问卷确定患者症状；病史和诊断检查来自健康记录。根据2015年ESC-ACS-GL，如果存在中等风险标准（IRC）或非侵入性，则认为CA是GL粘附性的，图像引导测试（NIGT）是病理性的。
■在2019年1月至2021年8月之间，在七个中心招募了229名患者。患者出现胸痛，呼吸困难,其他症状占66.7%，16.2%和17.1%，分别,平均年龄为66.3±10.5岁，36.3%为女性。根据2015年ESC-ACS-GL，64.0%的患者使用CA进行GL粘附.与未粘附使用CA相比，GL粘附导致血运重建的频率更高（44.5%vs.17.1%,p<0.001)。应用2020ESC-ACS-GL，20.4%的CA将保持GL粘附性。
■在大多数情况下，CA的使用遵循2015年ESC-ACS-GL.关于2020年和2023年ESC-ACS-GL，扩大NIGT利用的努力至关重要，特别是作为GL粘附使用CA更有可能导致血运重建。（德国临床试验注册DRKS00015638;https://drks。de/search/de/trial/DRKS00015638;（注册日期：2019年2月19日））。
■使用标准化问卷确定患者症状；病史和诊断检查来自健康记录。根据2015年ESC-ACS-GL，如果存在中等风险标准（IRC）或非侵入性，则认为CA是GL粘附性的，图像引导测试（NIGT）是病理性的。
■在2019年1月至2021年8月之间，在七个中心招募了229名患者。患者出现胸痛，呼吸困难,其他症状占66.7%，16.2%和17.1%，分别,平均年龄为66.3±10.5岁，36.3%为女性。根据2015年ESC-ACS-GL，64.0%的患者使用CA进行GL粘附.与未粘附使用CA相比，GL粘附导致血运重建的频率更高（44.5%vs.17.1%,p<0.001)。应用2020ESC-ACS-GL，20.4%的CA将保持GL粘附性。
■在大多数情况下，CA的使用遵循2015年ESC-ACS-GL.关于2020年和2023年ESC-ACS-GL，扩大NIGT利用的努力至关重要，特别是作为GL粘附使用CA更有可能导致血运重建。（德国临床试验注册DRKS00015638;https://drks。de/search/de/trial/DRKS00015638;（注册日期：2019年2月19日））。
