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Abstract：
BACKGROUND: At present, the diagnosis of acute coronary syndrome (ACS) can be made by emergency physicians using the usual complementary tests, since the current troponin and electrocardiogram (ECG) protocols have been extensively tested for their safety. However, the detection of coronary calcifications on CT associated with coronary obstruction may be of interest for the diagnostic strategy in the emergency department (ED). The aim of this study was to evaluate a strategy combining a non-ischemic ECG with an initial normal troponin assay and the diagnostic accuracy of chest CT in detecting coronary calcifications to rule out the presence of an acute coronary event in patients presenting with chest pain in the ED.
METHODS: This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED.
RESULTS: Of the 280 patients included, 141 didn\'t have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group.
CONCLUSIONS: A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone.
METHODS: This was a retrospective, single-center study carried out in an ED in France and included all patients over 18 years of age presenting with chest pain between 1 June 2021 and 31 December 2021 with a non-ischemic ECG and a negative first troponin assay. The primary endpoint was the diagnostic performance of the combing strategy in ruling out ACS. The secondary endpoints were the sensitivity and specificity of calcifications in acute coronary syndrome, comparison with the diagnostic performance of a second troponin assay and the rate of reconsultation, rehospitalisation and investigations within 2 months of the ED.
RESULTS: Of the 280 patients included, 141 didn\'t have calcifications. A total of 14 events were found with a negative predictive value for the combining strategy of 99.8% [95%CI: 98.2 - 100]. Sensitivity and specificity were 98.4% [95%CI: 83.8 - 100] and 53% [95%CI: 47 - 58.9], respectively. Among patients with no calcification, 8.2% were admitted to hospital and none suffered an acute coronary event. A total of 36 patients (12.8%) consulted a doctor within 2 months, with 23 investigations, all of which were negative in the non-calcification group.
CONCLUSIONS: A strategy combining the detection of coronary calcifications on chest CT in patients with a non-ischemic ECG and a single troponin assay is effective to rule out ACS in the ED, and may perform better then ECG and troponin alone.
摘要：
背景：目前，急性冠状动脉综合征（ACS）的诊断可以由急诊医师使用通常的补充测试，由于目前的肌钙蛋白和心电图（ECG）方案已经过广泛的安全性测试。然而,在CT上检测与冠状动脉阻塞相关的冠状动脉钙化可能对急诊科(ED)的诊断策略有意义.这项研究的目的是评估一种将非缺血性ECG与初始正常肌钙蛋白测定相结合的策略，以及胸部CT在检测冠状动脉钙化方面的诊断准确性，以排除在患有胸痛的患者中出现急性冠状动脉事件。ED。
方法：这是一个回顾性研究，单中心研究在法国的一个ED中进行,纳入了2021年6月1日至2021年12月31日期间出现胸痛的所有18岁以上患者,其非缺血性心电图和第一肌钙蛋白测定阴性.主要终点是排除ACS的梳理策略的诊断性能。次要终点是急性冠脉综合征钙化的敏感性和特异性,与第二次肌钙蛋白测定的诊断性能和再咨询率进行比较，ED后2个月内的再住院和调查。
结果：在280名患者中，141没有钙化。共发现14个事件，组合策略的阴性预测值为99.8%[95CI:98.2-100]。敏感性和特异性分别为98.4%[95CI：83.8-100]和53%[95CI：47-58.9]，分别。在没有钙化的患者中，8.2%的人入院，没有人发生急性冠脉事件。共有36例(12.8%)在2个月内咨询医生,有23项调查，非钙化组均为阴性.
结论：在非缺血性心电图和单一肌钙蛋白测定的患者中，结合胸部CT检测冠状动脉钙化的策略可有效排除ED中的ACS，并且可能比单独的心电图和肌钙蛋白表现更好。
方法：这是一个回顾性研究，单中心研究在法国的一个ED中进行,纳入了2021年6月1日至2021年12月31日期间出现胸痛的所有18岁以上患者,其非缺血性心电图和第一肌钙蛋白测定阴性.主要终点是排除ACS的梳理策略的诊断性能。次要终点是急性冠脉综合征钙化的敏感性和特异性,与第二次肌钙蛋白测定的诊断性能和再咨询率进行比较，ED后2个月内的再住院和调查。
结果：在280名患者中，141没有钙化。共发现14个事件，组合策略的阴性预测值为99.8%[95CI:98.2-100]。敏感性和特异性分别为98.4%[95CI：83.8-100]和53%[95CI：47-58.9]，分别。在没有钙化的患者中，8.2%的人入院，没有人发生急性冠脉事件。共有36例(12.8%)在2个月内咨询医生,有23项调查，非钙化组均为阴性.
结论：在非缺血性心电图和单一肌钙蛋白测定的患者中，结合胸部CT检测冠状动脉钙化的策略可有效排除ED中的ACS，并且可能比单独的心电图和肌钙蛋白表现更好。
