Acil serviste düşük olasılıklı akut koroner sendrom tanısı alan hastalarda kardiyogonyometrinin tanısal değerinin araştırılması
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Tarih
2018
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Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Acil servislerde travma dışı ölümlerin en sık nedeni koroner hastalıklardır. Dünya Sağlık Örgütü tarafından yayınlanan en son veriler, kardiyovasküler hastalığın dünya çapında ölümlerin önde gelen nedeni olduğunu göstermektedir. AKS’den şüphe edilen hastaların yönetiminde kılavuzlar, yönetim stratejisi ve bakım yeri seçimi için olasılık sınıflaması önermektedir ve düşük-orta olasılıklı hastalar acil servislerten taburcu edilmektedirler. Fakat Çalışmalar göstermektedir ki, acil servislerden göğüs ağrısı yakınması ile gelen hastaların %4-6’lık bir kısım hasta akut koroner sendrom tanısı atlanarak yanlışlıkla taburcu edilmektedir.6,7,8 Acil servislerde sık karşılaşılan AKS şüpheli hastaların doğru, hızlı ve güvenilir bir şekilde değerlendirilmesi ve uygun tetkik ve tedaviler için ilgili kliniklere yönlendirilmesi hayati önem arz etmektedir. AMAÇ: Acil servislerde “Düşük Olasılıklı AKS” protokolü sonucu taburculuk kararı verilen hastalarda (düşük-orta olasılık hastalar), miyokard perfüzyon sintigrafisi/tekli foton emisyonu bilgisayarlı tomografisi (SPECT) ile CGM’yi karşılaştırmak ve bu hastalarda CGM’nin tanısal değerini araştırmaktır. YÖNTEM: Çalışma etik kurul ve T.C. İlaç ve Tıbbi Cihaz kurumundan onayı alındıktan sonra, Ege Üniversitesi Tıp Fakültesi Acil Servis Kliniğinde Haziran 2017- Ekim 2018 tarihleri arasında yapıldı. Çalışmaya acil servise göğüs ağrısı, nefes darlığı gibi anjinal şikayetlerle getirilen ve acil servis izlemi sonucu “Düşük Olasılıklı AKS” tanısı konulan ve kardiyoloji hekimleri tarafından AKS ekarte edilmesi için Myokard Perfüzyon Gated SPECT planlanması için polikliniğe yönlendirilen 416 hasta alındı. Tüm hastalardan bilgilendirilmiş gönüllü olur onam formu alınarak CGM uygulandı. Acil hekimleri ve kardiyoloji hekimleri tanı ve tedavide herhangibir şekilde müdahalede bulunmadılar. CGM ölçümleri yatar durumdaki hastaya beş elektrodun yerleştirilmesiyle ve ticari olarak mevcut donanım ve yazılım (Cardiologic Explorer, enverdis, Jena, Almanya) kullanılarak elde edildi. ST-segment elevasyonlu miyokard enfarktüsü (STEMI), kardiyojenik şok, önemli kardiyak ektopik atımların varlığı, kalp pili (pacemaker) varlığı, acil serviste düşük orta olasılıklı gruba dahil olup izlem sonucu NSTEMI/AAP çıkan hastalar, CGM yapılamayan hastalar (hareketsiz veya soluksuz kalamayacaklar), myokard sintigrafisi istenmemiş veya herhangi bir nedenle yapılamayan hastalar ve çalışmaya katılmak istemeyen ve onamı alınamayan hastalar çalışma dışı bırakıldı. Acil servislerde “Düşük Olasılıklı AKS” protokolü sonucu taburculuk kararı verilen hastalarda(düşük-orta olasılık hastalar), birinci basamak merkezlerde gold standart olarak tanımlanan miyokard perfüzyon sintigrafisi ile CGM’nin tanısal etkinlikleri karşılaştırıldı. BULGULAR: Çalışma süresince acil servise göğüs ağrısı ve göğüs ağrısı eş değeri yakınmalar ile başvuran 6808 hastanın, 6392’si dışlama kriterlerini karşılaması nedeniyle ya da çalışmaya katılmayı ve/veya tedaviyi reddetmesi nedeniyle çıkarılması sonrası 416 hasta ile çalışma oluşturuldu. Bu hastalardan 193 tanesinin kardiyolojiye başvurması sonucu MPS yapılması ile çalışmanın esas verileri bu hastalar üzerinden oluşturuldu. Hastaların yaş ortalaması 50,34±12,47 olarak bulundu. En düşük yaş 18 iken en yüksek yaş 84 olarak tespit edildi. Bu hastaların %86,1’i (n=358) 65 yaş altında iken, %13,9’u (n=58) 65 ve üzeri yaş olarak bulundu. Çalışmaya alınan hastaların %52,4’ü(n=218)erkek, %47,6’sı (n=198) kadın olarak tespit edildi. Hastaların cinsiyetleri ve yaşları arasındaki ilişki incelendiğinde 65 yaş üstü hastaların %27,6 (n=16)erkek olduğu, %72,4(n=42) da kadın olduğu tespit edildi. Aralarında istatiksel olarak anlamlı fark olduğu görüldü(p<0,001).Hastaların yaş grupları ile komorbid hastalıkları arasındaki ilişkiye bakıldığında 65 yaş üstü hastaların %81’inin(n=47) en az bir adet komorbid hastalığı olduğu tespit edildi. 65 yaş altı hastalar ile kıyaslandığında komorbid hastalık açısıdan anlamlı fark olduğu görüldü(p<0,001). Yaş grupları ile yapılan MPS sonuçları arasındaki ilişkiye bakıldığında yaş ile MPS sonucu arasında uyum tespit edilmedi.(p=0,270). Hasta cinsiyetleri ile MPS sonuçları incelendiğinde MPS sonucu patolojik olan hastalardan %13,7’sinin(n=13)kadın, %19,4’ünün (n=19)erkek olduğu tespit edildi. Bu değerler ile arada anlamlı bir ilişki olmadığı tespit edildi. (p= 0,383) Hastaların geliş tansiyonları ile (p=0,715) ve geliş nabızları ile (p=0,280) MPS sonuçları arasında anlamlı bir ilişki tespit edilemedi. Hastaların %85,3’ü(n=355) göğüs ağrısı ile başvurdu. Hastaların komorbid hastalıkları değerlendirildiğinde %53,8(n=224) hastada en az bir komorbid hastalık olduğu tespit edilmiştir. %36,1 (n=150) hastada HT, %16,1(n=67) hastada da DM tanısı olduğu dikkat çekmiştir. Komorbid hastalıklar ile CGM sonuçlarının ilişkisi incelendiği zaman komorbid hastalığı olan hastaların %61,6’sının(n=130) CGM sonucu pozitif olarak değerlendirilmiştir. Bu bulgu istatiksel olarak anlamlı (p=0,001) olup komorbid hastalığı olan bireylerin CGM pozitifliğinin olması olasılığı daha yüksek hesaplanmıştır. HT ile CGM ilişkisi incelendiğinde HT tanısı olan hastaların CGM’lerinin pozitif çıkma ihtimali istatistiksel olarak daha yüksek tespit edilmiştir.( p=0,026) CGM pozitif değerlendirilen hastaların %41,2’sinin HT tanısı var iken, toplamda HT tanısı olan hastaların %57,4’ünün CGM pozitifliği durumu hipertansiyonun CGM pozitifleşmesi ile bağlantılı olduğunu doğrulamaktadır. Koroner arter hastalığı öyküsünün CGM sonuçlarını etkileyip etkilemediğine bakıldığında KAH tanısı olan hastaların sadece %1’inde(n=2) CGM negatif olarak sonuçlanmıştır. İstatiksel olarak değerlendirildiğinde KAH tanılı hastaların CGM ölçümlerinin pozitif sonuçlanma olasılığı anlamlı olarak yüksek hesaplanmıştır. (p=0,001) Antihipertansif kullanımına göre CGM sonuçlarının dağılımına bakıldığında antihipertansif kullanan hastaların anlamlı ölçüde oransal olarak CGM pozitifliği açısıdan daha fazla olduğu tespit edilmiştir. (p=0,040) Hastaların ilaç kullanımlarına bakıldığında %51,2(n=213) hastanın en az bir ilaç kullandığı, %48,8’inin(n=203) ilaç kullanmadığı bulunmuştur. En sık kullanılan ilaç%19 (n=79) ile betabloker olurken 2. En sık kullanılan ilaç %13,9 (n=58)ile oral antidiyabetikler olarak tespit edildi. Hastaların acil serviste kalış sürelerini konsültasyon istenme durumunun etkileyip etkilemedi bakıldığında konsültasyon istenen %25,5 (n=106) hastanın acil serviste 6 saatten fazla kalan sayının n=75 (%43,1) olduğu ve anlamlı olarak konsülte edilen hastaların daha uzun süre acilde kaldıkları tespit edildi. Konsülte edilmeyen hastaların (n=310) içlerinden %31,9’u acil serveste 6 saatten fazla kalırken, %68,1’i(n=211) istatistiksel olarak anlamlı olarak daha kısa süre acil serviste kalmıştır. Bu sonuçlar ile MPS’de patoloji olması durumuna göre hastaları ayırmadaki sensitivitesi, spesifisitesi, pozitif prediktif değeri, negatif prediktif değeri ve tanısal doğruluk oranları karşılaştırıldı. Çalışmaya alınan hastalarda CGM’nin düşük olasılıklı akut koroner sendrom tanısında altın standart olarak değerlendirilen MPS ile karşılaştırılması sonucunda, CGM’nin sensitivitesi 100%, spesifisitesi 55,28% olarak tespit edildi. Eş zamanlı olarak CGM’nin MPS’de patolojik sonuç veren hastalar için değerlendirmesinde pozitif prediktif değeri 30,77%, negatif prediktif değeri ise 100% olarak bulundu. CGM sonuçlarının MPS sonuçlarını tahmin etmedeki tanısal doğruluk oranı 62,69% olarak hesaplanmıştır. CGM’nin sensitivitesi ayırıcı tanıda kullandığımız EKG’den yüksek olarak saptanmıştır. EKG’nin sensitivitesi 62,50%, spesifisitesi 76,40% olarak tespit edildi. Bununla birlikte EKG’nin MPS patolojileri için değerlendirilmesinde pozitif prediktif değeri 34,48%, negatif prediktif değeri ise 91,11% olarak bulundu. EKG sonuçlarının MPS sonuçlarını tahmin etmedeki tanısal doğruluk oranı 74,09% olarak hesaplanmıştır. KAH ve HT tanısı olmayan diyabetik hastalarda EKG’de iskemik değişiklik olması durumunda CGM’nin spesifitesi, PPD ve doğruluk oranının arttığı tespit edilmiş olup, özellikle EKG’nin doğruluk oranının düştüğü diyabet gibi bir komorbid hastalıkta CGM’nin değerliliği kanıtlanmış oldu. Çalışmaya alınan hastalarda CGM‘nin gerçek hastalar içinden hastaları ayırma yeteneği 100% (95% güven aralığı 89,11% ila 100%) olduğu saptandı. Bu sonuç AKS takibinde kullanılan EKG’nin sensitivitesinden belirgin şeklide yüksek tespit edilmiştir.(tüm hasta grubunda EKG sensitivitesi 62,50%) Kardiyogonyometri düşük olasılıklı akut koroner sendrom ön tanılı hastalarda kullanılan diğer tanısal testler ile birlikte kullanıldığında hastaların daha hızlı ve daha kolay dışlanmasını sağlayacağı, taburculuk konusunda güven sağlayacağı ve acil servislerde düşük olasılıklı hastaların kalış sürelerini kısaltacağı için önemli bir tanısal araç olarak değerlendirilmiştir.
INTRODUCTION: Coronary diseases are the most common cause of non-traumatic deaths in emergency departments. The latest data published by the World Health Organization suggests that cardiovascular disease is the leading cause of deaths worldwide. In the management of patients suspected of ACS, guidelines recommend the probability classification for management strategy and choice of care place, and patients with low-middle probability are discharged from emergency services. However, studies show that 4-6% of patients with chest pain from the emergency department are discharged accidentally by skipping the diagnosis of acute coronary syndrome. It is of vital importance to evaluate and refer to relevant clinics for appropriate examinations and treatments. OBJECTIVE: To compare CGM with myocardial perfusion scintigraphy / single-photon emission computed tomography (SPECT) in patients who were discharged from the hospital with the Low-likelihood ACS protocol in emergency departments and to investigate the diagnostic value of CGM in these patients. METHOD: The study was conducted by the ethics committee, and it was held between June 2017 and October 2018 at the Emergency Service Clinic of Ege University Medical Faculty, after the approval of the T.C. Medicines and Medical Devices was obtained. The study included 416 patients who were admitted to the emergency department with anginal complaints such as chest pain, shortness of breath, and were referred to the outpatient clinic for the planning of Myocardial Perfusion Gated SPECT for the diagnosis of Low Probability ACS. All patients received informed consent form, and CGM was applied. Emergency physicians and cardiologists did not intervene in the diagnosis and treatment. CGM measurements were obtained by placing five electrodes on the lying patient and using commercially available hardware and software (Cardiologic Explorer, Enverdis, Jena, Germany). ST-segment elevation myocardial infarction (STEMI), cardiogenic shock, presence of significant cardiac ectopic beats, presence of pacemaker in the emergency department, low-middle risk group in follow-up NSTEMI / AAP patients follow-up ), patients who were not asked for myocardial scintigraphy or who could not be performed for any reason, and patients who did not want to participate in the study and who did not get consent were excluded from the study. The diagnostic efficacy of CGM in myocardial perfusion scintigraphy, which is defined as the gold standard in the first step centers, was compared in the patients who were given discharge decision as a result of the Low likelihood ACS protocol in emergency departments. RESULTS: The study included 4160 patients who were admitted to the emergency department with complaints of chest pain, and chest pain equivalent to 6808 patients and 6392 patients were excluded because of meeting the exclusion criteria or because they refused to participate in the study and/or refused treatment. The main data of the study were the MPS with the use of 193 of these patients. The mean age of the patients was 50.34 ± 12.47. The lowest age was 18, and the highest age was 84 years. While 86.1% (n = 358) of these patients were under 65 years of age, 13.9% (n = 58) were older than 65 years. Of the patients included in the study, 52.4% (n = 218) were male and 47.6% (n = 198) were female. The relationship between the sex and age of the patients was 27.6% (n = 16) were male, 72.4% (n = 42) were female. A statistically significant difference was found between them (p <0.001). The relationship between age groups and comorbid diseases was found to be 81% (n = 47) of patients over 65 years of age. There was a significant difference in comorbid diseases compared to patients under 65 years of age (p <0.001). There was no correlation between age and MPS results (p = 0.270). When MPS results were examined with the patients' gender, 13.7% (n = 13) of the patients with MPS were pathologic, and 19.4% (n = 19) were male. There was no significant relationship between these values. (p = 0,383) There was no significant relationship between MPS results and the patients' arrival tensions (p = 0,715) and arrival pulses (p = 0,280). 85.3% (n = 355) of the patients presented with chest pain. When the comorbid diseases of the patients were evaluated, it was found that 53.8% (n = 224) of the patients had at least one comorbid disease. It was noted that 36.1% (n = 150) had HT and 16.1% (n = 67) had DM. When the relationship between comorbid diseases and CGM results was examined, 61.6% (n = 130) of the patients with the comorbid disease were evaluated as positive. This finding was statistically significant (p = 0.001), and the probability of CGM positivity was higher in individuals with the comorbid disease. When the relationship between HT and CGM was investigated, it was found that HT diagnosis was statistically significant (p = 0.026), while 41,2% of patients with CGM were diagnosed with HT, while 57.4% of patients with HT had positive CGM. Confirms that hypertension is associated with CGM positive. When the history of coronary artery disease affects CGM results, only 1% (n = 2) of patients with CAD were negative for CGM. When evaluated statistically, the probability of the positive outcome of CGM measurements of patients with CAD was significantly higher. (p = 0.001) According to antihypertensive use, the distribution of CGM results was significantly higher than CGM positivity in patients with antihypertensive use. (P = 0.040) When the drug usage of the patients was examined, it was found that 51,2% (n = 213) of the patients used at least one drug and 48,8% (n = 203) were not using drugs. The most commonly used drug was beta blocker with 19% (n = 79). The most commonly used drug was found to be oral antidiabetic with 13,9% (n = 58). When the duration of stay in the emergency room was affected by the consultation request, 25,5% (n = 106) of the patients requested that the number of patients staying in the emergency room more than 6 hours was n = 75 (43.1%) and the patients who were consulted were in urgent care. Staying were detected. 31.9% of the patients who were not consulted (n = 310) remained in the emergency department for more than 6 hours, while 68,1% (n = 211) remained statistically shorter in the emergency department. According to these results, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates of the patients were compared according to the presence of pathology in MPS. As a result of the comparison of CGM with MPS which is considered as the gold standard in the diagnosis of low probability acute coronary syndrome in the patients included in the study, the sensitivity of CGM was found to be 100% and its specificity was 55.28%. Simultaneously, the positive predictive value of CGM for patients with pathologic results in MPS was 30.77%, and the negative predictive value was 100%. The diagnostic accuracy rate of CGM results in predicting MPS results was calculated as 62.69%. The sensitivity of CGM was found to be higher than the ECG used in the differential diagnosis. ECG sensitivity was found to be 62,50%, and specificity was 76,40%. However, the positive predictive value of ECG for MPS pathologies was 34.48%, and the negative predictive value was 91.11%. The diagnostic accuracy rate of the ECG results in estimating MPS results was calculated as 74.09%. CGM sensitivity was found 100% (95% confidence interval 89,11% to 100%) in the patients included in the study. This result was significantly higher than the sensitivity of ECG used in ACS follow-up (ECG sensitivity in all patient groups was 62,50%). Cardiogonyometry has been evaluated as an important diagnostic tool because it will enable patients to be faster and easier to exclude when they are used together with other diagnostic tests used in patients with the low-probability acute coronary syndrome, and they will provide confidence in discharge and shorten the stay of patients with low risk in emergency services. 100% (n = 32) of the patients who had pathological results in MPS were evaluated as positive in CGM. The positive evaluation of CGM of 72 (44.7%) patients with normal MPS results indicates that attention should be paid to overdiagnosis. With CGM's 100% (95% confidence interval, 89,11% to 100%) sensitivity and 100% negative predictive value, patients can safely be discharged with low/medium risk patients safely. It can be used as a possible first-line test for patients. CONCLUSION: Because of the high sensitivity of cardiogonyometry, it was concluded that chest pain and equivalent symptoms could be used as a screening test in patients with pre-diagnosis of low-to-medium probability ACS, but it could not be used as a definitive diagnostic test due to its low specificity. With CGM's 100% (95% confidence interval 89,11% to 100%) sensitivity and 100% negative predictive value, patients can be safely secured with low / medium probability patients with discharge. Due to the automatic interpretation of the results with simple and quick application, it can be used as a possible first-step test for patients. Due to the fact that it is a costefective examination that can be used to meet the patient during the ACS examination, it can be a very important one in reducing the number of emergency services in the light of the new studies conducted with the device. CGM result of patients negative, 0-6 cardiac enzyme monitoring is negative, ECG findings and ECG changes are not available from the emergency department can be safely discharged from the emergency service. The accuracy of CGM has been proven in a comorbid disease, such as diabetes, where the accuracy of ECG has decreased. In this type of patients, CGM may enter patient discharge algorithms in the future with new studies.
INTRODUCTION: Coronary diseases are the most common cause of non-traumatic deaths in emergency departments. The latest data published by the World Health Organization suggests that cardiovascular disease is the leading cause of deaths worldwide. In the management of patients suspected of ACS, guidelines recommend the probability classification for management strategy and choice of care place, and patients with low-middle probability are discharged from emergency services. However, studies show that 4-6% of patients with chest pain from the emergency department are discharged accidentally by skipping the diagnosis of acute coronary syndrome. It is of vital importance to evaluate and refer to relevant clinics for appropriate examinations and treatments. OBJECTIVE: To compare CGM with myocardial perfusion scintigraphy / single-photon emission computed tomography (SPECT) in patients who were discharged from the hospital with the Low-likelihood ACS protocol in emergency departments and to investigate the diagnostic value of CGM in these patients. METHOD: The study was conducted by the ethics committee, and it was held between June 2017 and October 2018 at the Emergency Service Clinic of Ege University Medical Faculty, after the approval of the T.C. Medicines and Medical Devices was obtained. The study included 416 patients who were admitted to the emergency department with anginal complaints such as chest pain, shortness of breath, and were referred to the outpatient clinic for the planning of Myocardial Perfusion Gated SPECT for the diagnosis of Low Probability ACS. All patients received informed consent form, and CGM was applied. Emergency physicians and cardiologists did not intervene in the diagnosis and treatment. CGM measurements were obtained by placing five electrodes on the lying patient and using commercially available hardware and software (Cardiologic Explorer, Enverdis, Jena, Germany). ST-segment elevation myocardial infarction (STEMI), cardiogenic shock, presence of significant cardiac ectopic beats, presence of pacemaker in the emergency department, low-middle risk group in follow-up NSTEMI / AAP patients follow-up ), patients who were not asked for myocardial scintigraphy or who could not be performed for any reason, and patients who did not want to participate in the study and who did not get consent were excluded from the study. The diagnostic efficacy of CGM in myocardial perfusion scintigraphy, which is defined as the gold standard in the first step centers, was compared in the patients who were given discharge decision as a result of the Low likelihood ACS protocol in emergency departments. RESULTS: The study included 4160 patients who were admitted to the emergency department with complaints of chest pain, and chest pain equivalent to 6808 patients and 6392 patients were excluded because of meeting the exclusion criteria or because they refused to participate in the study and/or refused treatment. The main data of the study were the MPS with the use of 193 of these patients. The mean age of the patients was 50.34 ± 12.47. The lowest age was 18, and the highest age was 84 years. While 86.1% (n = 358) of these patients were under 65 years of age, 13.9% (n = 58) were older than 65 years. Of the patients included in the study, 52.4% (n = 218) were male and 47.6% (n = 198) were female. The relationship between the sex and age of the patients was 27.6% (n = 16) were male, 72.4% (n = 42) were female. A statistically significant difference was found between them (p <0.001). The relationship between age groups and comorbid diseases was found to be 81% (n = 47) of patients over 65 years of age. There was a significant difference in comorbid diseases compared to patients under 65 years of age (p <0.001). There was no correlation between age and MPS results (p = 0.270). When MPS results were examined with the patients' gender, 13.7% (n = 13) of the patients with MPS were pathologic, and 19.4% (n = 19) were male. There was no significant relationship between these values. (p = 0,383) There was no significant relationship between MPS results and the patients' arrival tensions (p = 0,715) and arrival pulses (p = 0,280). 85.3% (n = 355) of the patients presented with chest pain. When the comorbid diseases of the patients were evaluated, it was found that 53.8% (n = 224) of the patients had at least one comorbid disease. It was noted that 36.1% (n = 150) had HT and 16.1% (n = 67) had DM. When the relationship between comorbid diseases and CGM results was examined, 61.6% (n = 130) of the patients with the comorbid disease were evaluated as positive. This finding was statistically significant (p = 0.001), and the probability of CGM positivity was higher in individuals with the comorbid disease. When the relationship between HT and CGM was investigated, it was found that HT diagnosis was statistically significant (p = 0.026), while 41,2% of patients with CGM were diagnosed with HT, while 57.4% of patients with HT had positive CGM. Confirms that hypertension is associated with CGM positive. When the history of coronary artery disease affects CGM results, only 1% (n = 2) of patients with CAD were negative for CGM. When evaluated statistically, the probability of the positive outcome of CGM measurements of patients with CAD was significantly higher. (p = 0.001) According to antihypertensive use, the distribution of CGM results was significantly higher than CGM positivity in patients with antihypertensive use. (P = 0.040) When the drug usage of the patients was examined, it was found that 51,2% (n = 213) of the patients used at least one drug and 48,8% (n = 203) were not using drugs. The most commonly used drug was beta blocker with 19% (n = 79). The most commonly used drug was found to be oral antidiabetic with 13,9% (n = 58). When the duration of stay in the emergency room was affected by the consultation request, 25,5% (n = 106) of the patients requested that the number of patients staying in the emergency room more than 6 hours was n = 75 (43.1%) and the patients who were consulted were in urgent care. Staying were detected. 31.9% of the patients who were not consulted (n = 310) remained in the emergency department for more than 6 hours, while 68,1% (n = 211) remained statistically shorter in the emergency department. According to these results, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates of the patients were compared according to the presence of pathology in MPS. As a result of the comparison of CGM with MPS which is considered as the gold standard in the diagnosis of low probability acute coronary syndrome in the patients included in the study, the sensitivity of CGM was found to be 100% and its specificity was 55.28%. Simultaneously, the positive predictive value of CGM for patients with pathologic results in MPS was 30.77%, and the negative predictive value was 100%. The diagnostic accuracy rate of CGM results in predicting MPS results was calculated as 62.69%. The sensitivity of CGM was found to be higher than the ECG used in the differential diagnosis. ECG sensitivity was found to be 62,50%, and specificity was 76,40%. However, the positive predictive value of ECG for MPS pathologies was 34.48%, and the negative predictive value was 91.11%. The diagnostic accuracy rate of the ECG results in estimating MPS results was calculated as 74.09%. CGM sensitivity was found 100% (95% confidence interval 89,11% to 100%) in the patients included in the study. This result was significantly higher than the sensitivity of ECG used in ACS follow-up (ECG sensitivity in all patient groups was 62,50%). Cardiogonyometry has been evaluated as an important diagnostic tool because it will enable patients to be faster and easier to exclude when they are used together with other diagnostic tests used in patients with the low-probability acute coronary syndrome, and they will provide confidence in discharge and shorten the stay of patients with low risk in emergency services. 100% (n = 32) of the patients who had pathological results in MPS were evaluated as positive in CGM. The positive evaluation of CGM of 72 (44.7%) patients with normal MPS results indicates that attention should be paid to overdiagnosis. With CGM's 100% (95% confidence interval, 89,11% to 100%) sensitivity and 100% negative predictive value, patients can safely be discharged with low/medium risk patients safely. It can be used as a possible first-line test for patients. CONCLUSION: Because of the high sensitivity of cardiogonyometry, it was concluded that chest pain and equivalent symptoms could be used as a screening test in patients with pre-diagnosis of low-to-medium probability ACS, but it could not be used as a definitive diagnostic test due to its low specificity. With CGM's 100% (95% confidence interval 89,11% to 100%) sensitivity and 100% negative predictive value, patients can be safely secured with low / medium probability patients with discharge. Due to the automatic interpretation of the results with simple and quick application, it can be used as a possible first-step test for patients. Due to the fact that it is a costefective examination that can be used to meet the patient during the ACS examination, it can be a very important one in reducing the number of emergency services in the light of the new studies conducted with the device. CGM result of patients negative, 0-6 cardiac enzyme monitoring is negative, ECG findings and ECG changes are not available from the emergency department can be safely discharged from the emergency service. The accuracy of CGM has been proven in a comorbid disease, such as diabetes, where the accuracy of ECG has decreased. In this type of patients, CGM may enter patient discharge algorithms in the future with new studies.
Açıklama
Anahtar Kelimeler
Kardiyogonyometri, Akut Koroner Sendrom, EKG, CGM, Düşük Olasılıklı AKS, Cardiogoniometri, Acute Coronary Syndrome, ECG, CGM, Low-Probability ACS
