Angiographic extent of coronary artery stenosis in patients with high and intermediate likelihood of unstable angina according to likelihood classification of American Heart Association
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Tarih
2007
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info:eu-repo/semantics/openAccess
Özet
Amaç: AHA/ACC klinik uygulama kılavuzuna göre, göğüs ağrısı ile başvuran tüm hastaların koroner arter hastalığına bağlı akut iskemi olasılığı yüksek, orta ya da düşük olarak belirlenmelidir. Bu çalışma, AHA olasılık sınıflamasına göre, yüksek ya da orta olasılıklı kararsız anjinalı hastalardaki belirgin koroner arter hastalığının yaygınlığını tespit etmeyi hedeflemektedir. Yöntemler: Kararsız anjinayı düşündüren semptom ve bulgularla başvuran, acil serviste yüksek ve orta olasılıklı sınıflandırılan ve 1 hafta içerisinde koroner anjiyografi yapılan ardışık 133 hasta çalışmaya alındı. Hastaların özellikleri alt gruplarına göre koroner anjiyografi bulguları ile karşılaştırıldı. Bulgular: Yüksek olasılıklı hastalarda (n=89) koroner anjiyografi, 62 belirgin koroner arter hastalığı (KAH), 7 orta KAH, 20 hafif KAH ya da normal koroner arteri ortaya koydu. Orta olasılıklı hastalarda (n=19) koroner anjiyografi, 2 belirgin KAH, 17 hafif KAH ya da normal koroner arteri ortaya koydu. Belirgin koroner arter hastalığı, yüksek olasılıklı hastalarda daha belirgin sıklıkta bulundu (p<0.001, olasılıklar oranı 23.97, 95% güven aralığı 4.21-90.43). En az bir yüksek olasılık kriterine sahip olmanın, belirgin koroner arter hastalığını tespit etmedeki duyarlılığı ve seçiciliği, sırası ile %96.8 ve %38.6 bulundu. Sonuç: Acil servislerde kararsız anjinalı hastaların triajında olasılık sınıflamasının kullanımının yararlı olacağını düşünüyoruz. Daha ileri çalışmalarla desteklediği takdirde, bu sınıflamanın kullanımı, göğüs ağrısı ile başvuran hastalarda ciddi koroner arter hastalığını önceden belirlemede ya da dışlamada yüksek tanısal doğrululuk sağlayabilir.
Objective: in accordance with the AHA/ACC clinical practice guideline, the likelihood of acute ischemia caused by coronary artery disease (CAD) is to be determined as high, intermediate, or low for all patients presenting with chest discomfort. This study was conducted to estimate extent of significant CAD in patients with high and intermediate likelihood of unstable angina (UA) according to “AHA likelihood classification“ Methods: Overall, 133 consecutive patients presented with symptoms or signs suggestive of UA, which was classified as of high or intermediate likelihood in Emergency Department (ED), and undergoing coronary angiography (CAG) within one week were enrolled into the study. the characteristics of the patients in either subgroup were compared in terms of the findings of the CAG. Results: in patients with high likelihood of UA (n=89), CAG revealed that 62 had significant CAD, 7 - moderate CAD, 20 - mild CAD or normal coronary angiogram. in patients with intermediate likelihood of UA (n=19), CAG revealed that 2 patients had significant CAD, and 17 - mild CAD or normal coronary angiogram. the rate of significant CAD was significantly higher in patients with high likelihood (p<0.001, LR 23.97, 95% CI 4.21-90.43). the sensitivity and specificity of having at least one of high likelihood features for detecting significant CAD were found to be 96.8% and 38.6% respectively. Conclusion: We suggest that the likelihood classification is useful for the triage of the UA patients in the ED. When supported with further studies, utilization of this classification will yield a high diagnostic accuracy in predicting or ruling out severe CAD in patients presenting with chest pain.
Objective: in accordance with the AHA/ACC clinical practice guideline, the likelihood of acute ischemia caused by coronary artery disease (CAD) is to be determined as high, intermediate, or low for all patients presenting with chest discomfort. This study was conducted to estimate extent of significant CAD in patients with high and intermediate likelihood of unstable angina (UA) according to “AHA likelihood classification“ Methods: Overall, 133 consecutive patients presented with symptoms or signs suggestive of UA, which was classified as of high or intermediate likelihood in Emergency Department (ED), and undergoing coronary angiography (CAG) within one week were enrolled into the study. the characteristics of the patients in either subgroup were compared in terms of the findings of the CAG. Results: in patients with high likelihood of UA (n=89), CAG revealed that 62 had significant CAD, 7 - moderate CAD, 20 - mild CAD or normal coronary angiogram. in patients with intermediate likelihood of UA (n=19), CAG revealed that 2 patients had significant CAD, and 17 - mild CAD or normal coronary angiogram. the rate of significant CAD was significantly higher in patients with high likelihood (p<0.001, LR 23.97, 95% CI 4.21-90.43). the sensitivity and specificity of having at least one of high likelihood features for detecting significant CAD were found to be 96.8% and 38.6% respectively. Conclusion: We suggest that the likelihood classification is useful for the triage of the UA patients in the ED. When supported with further studies, utilization of this classification will yield a high diagnostic accuracy in predicting or ruling out severe CAD in patients presenting with chest pain.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Anadolu Kardiyoloji Dergisi
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Scopus Q Değeri
Cilt
7
Sayı
3
