Acil serviste ST yükselmesiz myokard infarktüsü (NSTEMI) ve anstabil anjina pektoris (AAP) hastalarının tanısında kardiyogonyometrinin tanısal değerinin araştırılması
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Tarih
2018
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Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Dünya üzerinde en sık ölüm nedenlerinden biri olduğu bilinen iskemik kalp hastalıklarına, acil tıp hekimlerinin sıklıkla ilk karşılaşan hekim grubu olması; onların bu konudaki deneyimlerini arttırmış durumdadır. Ülkemizde hastane başvurularının %40'tan fazlasını kabul eden acil servislerde yaşamı tehdit eden akut koroner sendrom tanısını hızlı ve doğru bir şekilde koymak hayati önem arz etmektedir. AMAÇ: Acil serviste ST yükselmesiz miyokard enfarktüsü (NSTEMI) ve anstabil anjina pektoris hastalarının tanısında kardiyogonyometrinin tanısal değerinin incelenmesi. YÖNTEM: Çalışmamız Ege Üniversitesi Etik Kurulu onayı ve T.C. İlaç ve Tıbbi Cihaz kurumundan onay alındıktan sonra Kasım 2016- Nisan 2018 tarihleri arasında yapıldı. Toplam üç merkezde (Ege Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı, Ümraniye Eğitim Araştırma Hastanesi Acil Tıp Kliniği, Ankara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalı) acil servise göğüs ağrısı ve eşleniği şikayetler ile başvuran ve sonuçta AAP veya NSTEMI tanısı almış ve koroner anjiyografi için yatış yapılmış 341 hasta alındı. Tüm hastalardan bilgilendirilmiş gönüllü olur onam formu alınarak CGM uygulandı. Hastaların acil serviste yapılan diğer tanı ve tedavi süreçlerine müdehale edilmedi. İlk başvuruda STEMI tanısı alması, solunum durması, kalp durması, ciddi bilinç değişikliği, ventriküler fibrilasyon, ventriküler taşikardi saptanması, anstabil taşikardi, anstabil bradikardi, hastanın düz yatırılamayacağı kadar ciddi kalp yetmezliği ve akciğer ödemi olması, kardiyojenik şok, önemli kardiyak ektopik atımların varlığı, kalp pili (pacemaker) varlığı, taşikardi (150 atım/dak.,demet dal bloğu ve/veya atrial fibrilasyon), CGM yapılamayan hastalar (hareketsiz veya soluksuz kalamayacaklar), koroner anjiyografi yapılmayan veya yapılamayan hastalar, çalışmaya katılmak istemeyen ve onamı alınamayan hastalar çalışma dışı bırakıldı. Yapılan koroner anjiyografilerin CGM sonucuna kör bir kardiyoloji hekimi tarafından yorumlanması sağlandı. Akut koroner sendrom tanısında altın standart olan koroner anjiyografi sonuçları ile CGM ve diğer tanısal testlerin sonuçları karşılaştırılarak tanısal etkinlik araştırıldı. BULGULAR: Çalışma boyunca acil servise göğüs ağrısı ve eşleniği yakınma ile başvuran 6205 hastanın, 5356 kadarı dışlama kriterlerini karşıladığı için ve geriye kalan hastalardan çeşitli sebepler ile (hasta reddi, yaş komorbidite sebebi ile medikal izlem kararı alınan veya koroner anjiyografi sonucuna ulaşılamayan) koroner anjiyografi yapılmayan hastalar çalışma dışı bırakıldıktan sonra, geriye kalan 341 hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 59,5±12,5'di. Hastaların %69,5'i (n=237) 65 yaş altındaydı. NSTEMI tanısı alan hastalar istatistiksel anlamlı olarak daha ileri yaşlardaydı (p<0,001). 65 yaş üstü hastalarda koroner anjiyografi sonucunda %50'nin üzerinde darlık tespit edilen hasta sayısı istatistiksel anlamlı olarak daha fazlaydı (p<0,001). Çalışmaya alınan hastaların %67,4'ü (n=230) erkek, %32,6'sı (n=111) kadındı. Erkek hastaların 65 yaş altındaki hastaların %73'ünü oluşturduğu ve bu nedenle 65 yaş altındaki NONSTE-AKS tanılarının istatistiksel anlamlı olarak erkek cinsiyette daha fazla bulunduğu tespit edildi (p=0,001). Koroner anjiyografi sonuçları cinsiyete göre değerlendirildiğinde erkek hastaların %77,8'inde (n=179) koroner anjiyografi sonucunda %50'inin üzerinde darlık tespit edildiği ve bu nedenle erkek cinsiyette koroner anjiyografide anlamlı kritik darlığın istatistiksel anlamlı olarak daha fazla olduğu tespit edildi (p=0,001). Çalışmaya alınan hastalarda en sık görülen başvuru şikayeti %88,3 (n=284) ile göğüs ağrısıydı. Hastaların %80,9'u (n=276) en az bir komorbid hastalığa sahipti. En sık komorbid hastalıklar sırasıyla hipertansiyon, eski koroner hastalığı ve diyabetes mellitus idi ve herbirinin varlığında koroner anjiyografide %50'nin üzerinde darlık bulunan hasta sayısı istatistiksel anlamlı olarak daha fazlaydı (sırasıyla p=0,015, p=0,004 ve p<0,001). Hastaların %34,9'unda (n=119) AAP, %65,1'inde (n=222) NSTEMI saptandı. Acil serviste NSTEMI tanısı alan hastalarda koroner anjiyografide %50'nin üzerinde darlık tespit edilme oranı AAP'ye göre istatistiksel anlamlı olarak daha fazlaydı (p<0,001). Hastaların acil serviste kalış süreleri 1 saat ile 31 saat ile değişmekteydi. AAP tanısı alan hastaların acil serviste ortalama kalış süresi 5,7±2,9 saat iken NSTEMI tanısı alan hastaların ortalama kalış süresi 7,4±4,9 saatti. NSTEMI tanısı alan hastaların acil serviste kalış süreleri AAP'ye göre istatistiksel anlamlı olarak daha uzundu (p=0,004). Bu sonuçlar ile tanısal testlerin gold standart olan koroner anjiyografiye göre koroner damarlarda %50'nin üzerinde darlık olan hastaları ayırmadaki sensitivitesi, spesifisitesi, pozitif prediktif değeri, negatif prediktif değeri ve tanısal doğruluk oranları karşılaştırıldı. Çalışmaya alınan hastalarda CGM'nin akut koroner sendrom tanısında altın standart olarak kabul edilen koroner anjiyografi ile karşılaştırılması sonucunda, CGM'nin sensitivitesinin % 93,5 olduğu saptandı. CGM'nin sensitivitesi negatif troponin ile karakterize AAP tanılı hasta grubunda %92,4, NSTEMİ hasta grubunda %98,8'di. CGM'nin sensitivitesi ayırıcı tanıda kullandığımız EKG ve birinci troponin değerlerinden tüm alt gruplarda yüksek olarak saptanmıştır (tüm hastalarda EKG %57,9, seri EKG %59,1, birinci troponin %73,6 ve seri troponin bakılma endikasyonu konulan hastalarda %86,9). CGM'nin spesifitesi ise tüm NSTE-AKS'lerde %39,6 olarak bulunmuştur. CGM'nin pozitif prediktif değeri %80,2 iken, NSTEMI hasta grubunda %92,3 olarak tespit edilmiş ve pozitif troponin testi ile karakterize NSTEMI hasta grubunda izole birinci troponin testinin pozitif prediktif değerinin (%89,6) olarak tespit edilmiştir. CGM'nin negatif prediktif değeri tüm NSTE-AKS'lerde %69,8 olup, AAP hasta grubunda %85,7, NSTEMI hasta grubunda %52 olarak bulunmuştur. Kardiyogonyometri akut koroner sendromda kullanılan diğer tanısal testler ile birlikte kullanıldığında tanısal doğruluğu artırmaktadır. EKG'de iskemik bulgu olan hastalarda CGM pozitifliği, gold standart koroner anjiyografiye göre anlamlı kritik darlık olan hastalarda %97,3'tür. Bu oran yalnızca EKG'de iskemi için spesifik özellik olan hastalarda %57,9'dur. Birinci troponin negatif olan hastalarda CGM negatif olan hastaların %87,1'inde koroner anjiyografi sonucunda %50'nin altında darlık tespit edilmiştir. Bu oran yalnızca birinci troponin negatif olan hastalarda %50'dir. EKG'de iskemi için spesifik özellik olan ve birinci troponin pozitif olan hastalarda CGM'nin tanısal doğruluğu %88,2 iken, yalnızca EKG ve birinci troponin birlikte kullanıldığında bu oran %72,2'dir.Çalışmaya alınan hastalarda rutinde kullandığımız klinik ölçütler ile erken invaziv girişim kararı verdiğimiz hastaların %72,4'ünde (n=247) koroner anjiyografi sonucunda %50'nin üzerinde darlık tespit edilmiş iken, yalnızca CGM pozitif olan hastaların %80,2'sinde (n=231) koroner anjiyografi sonucunda %50'nin üzerinde darlık tespit edilmiştir. SONUÇ: Kardiyogonyometri yüksek sensitivitesi sebebi ile göğüs ağrısı ve eşleniği şikayetler ile acil servise başvuran hastalarda NSTE-AKS tanısı için tarama testi olarak kullanılabileceği, CGM negatif olan hastaların %30,2 sinde (n=16) koroner anjiyografi sonucunda %50'nin üzerinde darlık tespit edildiğinden, CGM'nin NSTE-AKS'lerde düşük spesifisitesi nedeniyle kesin tanı koydurucu test olarak kullanılamayacağı düşünülmüştür. AAP hasta grubunda mevcut klinik ölçütlerle tanı koyup koroner anjiyografiye yönlendirdiğimiz hastaların (n=119) %44,5'inde (n=53) koroner anjiyografi sonucunda %50'nin altında darlık tespit edildiğinden AAP hasta grubunda yüksek negatif prediktif değeri sebebiyle hastaları taburculuk algoritmleri içerisine dahil edilebilir. CGM diğer tanısal testler ile birlikte kullanıldığında testlerin sensitivitesini ve tanısal doğruluğunu artırmaktadır.
INTRODUCTION: Emergency medicine physicians have a vast majority of experiences in ischemic heart diseases, which are well-known to be one of the most common causes of mortality in the World, as they are often the first group of physicians in encountering these diseases. It is important to diagnose the life-threatening acute coronary syndromes promptly and accurately in the emergency departments, which accept more than 40% of patients arriving at hospitals in our country. OBJECTIVE: The aim of the study is to investigate the diagnostic value of cardiogoniometry (CGM) in identifying patients with non-ST segment elevation acute myocardial infarction (NSTEMI) and patients with unstable angina pectoris in the emergency department. METHOD: Our study was conducted between November 2016 and April 2018 after the approvals of Ege University Ethics Committee and of Turkish Medicines and Medical Devices Agency had been granted. A total of 341 patients presenting in the emergency department with chest pain and correlated complaints, who were diagnosed with either NSTEMI or UAP, and who were hospitalized to undergo a coronary angiogram were included in the study at three study sites (Ege University, Faculty of Medicine, Department of Emergency Medicine; Ümraniye Training and Research Hospital, Department of Emergency Medicine; and Ankara Yıldırım Beyazıt University, Medical Faculty, Department of Emergency Medicine). After collecting the informed consent forms from all volunteering patients, CGM was performed in each patient. Other diagnostic or treatment procedures, which the study patients would undergo, were not intervened in the emergency department. The patients were excluded at baseline if they were diagnosed with STEMI, ventricular fibrillation or ventricular tachycardia; if they developed a respiratory arrest or cardiac arrest, if they had severe changes in consciousness, if they had unstable tachycardia or unstable bradycardia, had a severe cardiac failure or pulmonary edema not allowing the patient to lie flat, if they were in cardiogenic shock, if they had significant cardiac ectopic beats, had cardiac pacemakers, had tachycardia (150 beats/min, bundle branch block and/or atrial fibrillation), had a contraindication for performing CGM (patients who cannot lie down still and who cannot comply with the orders of not to breathe), if they did not or was not able to undergo a coronary angiogram, if they were unwilling to participate in the study and if they did not consent to the study. Coronary angiograms were interpreted by a cardiologist blinded to the results of CGM results. The diagnostic efficacy was investigated by comparing the results of the coronary angiogram, which is a golden standard in diagnosing an acute coronary syndrome, with those of CGM and of the other diagnostic tests. RESULTS: Of the 6205 patients who presented at the emergency department with the complaints of chest pain and correlated symptoms; a total of 341 patients were included in the study because 5356 patients were excluded as they did not comply with the inclusion criteria and as the remaining patients were excluded because they did not undergo a coronary angiogram due to various reasons (patients who were decided to be followed-up medically due to patient's rejection, due to the age of the patients or due to presence of comorbidities. The patients were excluded, too, if their coronary angiograms were unavailable). The mean age of the patients was 59.5±12.5 years. The ratio of the patients under the age of 65 was 69.5% (n=237) of the study population. The patients who were diagnosed with NSTEMI were aged older statistically significantly (p<0.001). The number of patients over the age of 65 and who were identified with a stenosis of more than 50% in the coronary angiograms were statistically significantly higher (p<0.001). Of the patients in the study, 67.4% (n=230) were males and 32.6% (n=111) were females. Male patients below 65 years of age constituted 73% of the study patients, therefore, it was determined that the number of diagnoses of NON-STE-acute coronary syndrome (ACS) in patients under 65 years was statistically significantly higher in males (p=0.001). Evaluation of the coronary angiogram results by gender revealed that 77.8% (n=179) of male patients were identified with a stenosis of more than 50% in the coronary angiograms, therefore, it was determined that the number of critical stenoses identified at the coronary angiograms was statistically significantly higher in males (p=0.001). The most frequent complaint in the study patients was the chest pain with a rate of 88.3% (n=284). The patients having at least one comorbid disease constituted 80.9% (n=276) of the study population. The most common comorbid diseases were hypertension, a previous coronary disease, and diabetes mellitus, respectively. The number of patients with a stenosis of more than 50% identified at the coronary angiogram and who had either of these comorbid diseases was statistically significantly higher (p= 0.015, p=0.004, and p<0.001 respectively for each of the above-mentioned three comorbidities). Of the study patients, 34.9% (n=119) were diagnosed with UAP and 65.1% (n=222) were diagnosed with NSTEMI. Compared to the patients who were diagnosed with UAP at the emergency department, the rate of identifying of a stenosis of more than 50% in the coronary angiograms was statistically significantly higher in the patients who were diagnosed with NSTEMI at the emergency department (p<0.001). The patients' duration of stay in the emergency department ranged from 1 hour to 31 hours. The mean duration of stay in the emergency department for the patients who were diagnosed with UAP was 5.7±2.9 hours while the mean duration of stay of patients who were diagnosed with NSTEMI was 7.4±4.9 hours. The duration of stay in the emergency department was statistically significantly longer for the patients diagnosed with NSTEMI compared to the patients with AAP (p=0.004). After obtaining these results; the sensitivities, specificities, positive predictive values, negative predictive values, and the diagnostic accuracies of the diagnostic tests were compared to those of coronary angiogram at identifying the patients with a stenosis of more than 50% in the coronary arteries. The sensitivity of CGM was found to be 93.5% compared to the coronary angiogram which is recognized as the golden standard in diagnosing an acute coronary syndrome. The sensitivity values of CGM were 92.4% and 98.8% in the patients with UAP characterized by a negative troponin finding and in the patients with UAP, respectively. The sensitivity of CGM was found out to be higher than the sensitivities of ECG and the first troponin tests in all sub-groups (57.9% for ECG, 59.1% for serial ECG, 73.6% for the first troponin levels in all patients. It was 86.9% for the serial troponin levels for the patients with an indication for this test). The specificity of CGM was found out to be 39.6% in all patients with NSTE-ACS. The positive predictive value of CGM was 80.2% and it was found out to be 92.3% in the NSTEMI patient group. The positive predictive value of a troponin test result only was found out to be 89.6% in the NSTEMI patients characterized by a positive troponin test. While the negative predictive value of CGM was 69.8% in all patients with NSTE-ACS, it was found out to be 85.7% in the UAP patient group and 52% in the NSTEMI patient group. Cardiogoniometry enhanced the diagnostic accuracy when it was used in combination with other diagnostic tests employed in making the diagnosis of an acute coronary syndrome. CGM positivity in patients with ischemic findings in ECG was 97.3% in patients with significant critical stenosis in the coronary angiography, which is the golden standard. This ratio was 57.9% only in patients with specific characteristic findings of ischemia in the ECG. Of the patients with a negative troponin value at the first test and in patients with a negative CGM, 87.1% were identified with a stenosis of less than 50% in the coronary angiogram. This ratio was 50% only in patients with a negative troponin value at the first test. The diagnostic accuracy of CGM was 88.2% in the patients with specific findings for ischemia in ECG and with a positive troponin value at the first test, however, it was 72.2% when ECG alone and the results of the first troponin tests were used in combination. By using the routine clinical criteria, of the study patients who were decided to undergo an early invasive intervention, 72.4% (n=247) of the patients were identified with a stenosis of more than 50% in the coronary angiogram, whereas, of the patients with positive CGM only, 80.2% (n=231) were identified with a stenosis of more than 50% in the coronary angiogram CONCLUSION: It is concluded that, because of its high sensitivity, cardiogoniometry (CGM) can be used as a screening test for the diagnosis of NSTE-ACS in patients presenting with chest pain and correlated complaints in the emergency departments, however CGM cannot be used in making the diagnosis of NSTE-ACS due to its lower specificity as 30.2% (N=16) of the CGM-negative patients were identified with a stenosis of more than 50% in coronary angiograms. Because 44.5% (n=53) of the patients diagnosed with UAP using the existing clinical criteria (n=119) were identified with a stenosis of less than 50% when they were referred to undergo a coronary angiogram and because CGM has a higher negative predictive value, it can be included in the diagnostic tests performed for discharging patients from the hospital. When CGM is used in conjunction with other diagnostic tests, it enhances the sensitivity and diagnostic accuracy of these tests.
INTRODUCTION: Emergency medicine physicians have a vast majority of experiences in ischemic heart diseases, which are well-known to be one of the most common causes of mortality in the World, as they are often the first group of physicians in encountering these diseases. It is important to diagnose the life-threatening acute coronary syndromes promptly and accurately in the emergency departments, which accept more than 40% of patients arriving at hospitals in our country. OBJECTIVE: The aim of the study is to investigate the diagnostic value of cardiogoniometry (CGM) in identifying patients with non-ST segment elevation acute myocardial infarction (NSTEMI) and patients with unstable angina pectoris in the emergency department. METHOD: Our study was conducted between November 2016 and April 2018 after the approvals of Ege University Ethics Committee and of Turkish Medicines and Medical Devices Agency had been granted. A total of 341 patients presenting in the emergency department with chest pain and correlated complaints, who were diagnosed with either NSTEMI or UAP, and who were hospitalized to undergo a coronary angiogram were included in the study at three study sites (Ege University, Faculty of Medicine, Department of Emergency Medicine; Ümraniye Training and Research Hospital, Department of Emergency Medicine; and Ankara Yıldırım Beyazıt University, Medical Faculty, Department of Emergency Medicine). After collecting the informed consent forms from all volunteering patients, CGM was performed in each patient. Other diagnostic or treatment procedures, which the study patients would undergo, were not intervened in the emergency department. The patients were excluded at baseline if they were diagnosed with STEMI, ventricular fibrillation or ventricular tachycardia; if they developed a respiratory arrest or cardiac arrest, if they had severe changes in consciousness, if they had unstable tachycardia or unstable bradycardia, had a severe cardiac failure or pulmonary edema not allowing the patient to lie flat, if they were in cardiogenic shock, if they had significant cardiac ectopic beats, had cardiac pacemakers, had tachycardia (150 beats/min, bundle branch block and/or atrial fibrillation), had a contraindication for performing CGM (patients who cannot lie down still and who cannot comply with the orders of not to breathe), if they did not or was not able to undergo a coronary angiogram, if they were unwilling to participate in the study and if they did not consent to the study. Coronary angiograms were interpreted by a cardiologist blinded to the results of CGM results. The diagnostic efficacy was investigated by comparing the results of the coronary angiogram, which is a golden standard in diagnosing an acute coronary syndrome, with those of CGM and of the other diagnostic tests. RESULTS: Of the 6205 patients who presented at the emergency department with the complaints of chest pain and correlated symptoms; a total of 341 patients were included in the study because 5356 patients were excluded as they did not comply with the inclusion criteria and as the remaining patients were excluded because they did not undergo a coronary angiogram due to various reasons (patients who were decided to be followed-up medically due to patient's rejection, due to the age of the patients or due to presence of comorbidities. The patients were excluded, too, if their coronary angiograms were unavailable). The mean age of the patients was 59.5±12.5 years. The ratio of the patients under the age of 65 was 69.5% (n=237) of the study population. The patients who were diagnosed with NSTEMI were aged older statistically significantly (p<0.001). The number of patients over the age of 65 and who were identified with a stenosis of more than 50% in the coronary angiograms were statistically significantly higher (p<0.001). Of the patients in the study, 67.4% (n=230) were males and 32.6% (n=111) were females. Male patients below 65 years of age constituted 73% of the study patients, therefore, it was determined that the number of diagnoses of NON-STE-acute coronary syndrome (ACS) in patients under 65 years was statistically significantly higher in males (p=0.001). Evaluation of the coronary angiogram results by gender revealed that 77.8% (n=179) of male patients were identified with a stenosis of more than 50% in the coronary angiograms, therefore, it was determined that the number of critical stenoses identified at the coronary angiograms was statistically significantly higher in males (p=0.001). The most frequent complaint in the study patients was the chest pain with a rate of 88.3% (n=284). The patients having at least one comorbid disease constituted 80.9% (n=276) of the study population. The most common comorbid diseases were hypertension, a previous coronary disease, and diabetes mellitus, respectively. The number of patients with a stenosis of more than 50% identified at the coronary angiogram and who had either of these comorbid diseases was statistically significantly higher (p= 0.015, p=0.004, and p<0.001 respectively for each of the above-mentioned three comorbidities). Of the study patients, 34.9% (n=119) were diagnosed with UAP and 65.1% (n=222) were diagnosed with NSTEMI. Compared to the patients who were diagnosed with UAP at the emergency department, the rate of identifying of a stenosis of more than 50% in the coronary angiograms was statistically significantly higher in the patients who were diagnosed with NSTEMI at the emergency department (p<0.001). The patients' duration of stay in the emergency department ranged from 1 hour to 31 hours. The mean duration of stay in the emergency department for the patients who were diagnosed with UAP was 5.7±2.9 hours while the mean duration of stay of patients who were diagnosed with NSTEMI was 7.4±4.9 hours. The duration of stay in the emergency department was statistically significantly longer for the patients diagnosed with NSTEMI compared to the patients with AAP (p=0.004). After obtaining these results; the sensitivities, specificities, positive predictive values, negative predictive values, and the diagnostic accuracies of the diagnostic tests were compared to those of coronary angiogram at identifying the patients with a stenosis of more than 50% in the coronary arteries. The sensitivity of CGM was found to be 93.5% compared to the coronary angiogram which is recognized as the golden standard in diagnosing an acute coronary syndrome. The sensitivity values of CGM were 92.4% and 98.8% in the patients with UAP characterized by a negative troponin finding and in the patients with UAP, respectively. The sensitivity of CGM was found out to be higher than the sensitivities of ECG and the first troponin tests in all sub-groups (57.9% for ECG, 59.1% for serial ECG, 73.6% for the first troponin levels in all patients. It was 86.9% for the serial troponin levels for the patients with an indication for this test). The specificity of CGM was found out to be 39.6% in all patients with NSTE-ACS. The positive predictive value of CGM was 80.2% and it was found out to be 92.3% in the NSTEMI patient group. The positive predictive value of a troponin test result only was found out to be 89.6% in the NSTEMI patients characterized by a positive troponin test. While the negative predictive value of CGM was 69.8% in all patients with NSTE-ACS, it was found out to be 85.7% in the UAP patient group and 52% in the NSTEMI patient group. Cardiogoniometry enhanced the diagnostic accuracy when it was used in combination with other diagnostic tests employed in making the diagnosis of an acute coronary syndrome. CGM positivity in patients with ischemic findings in ECG was 97.3% in patients with significant critical stenosis in the coronary angiography, which is the golden standard. This ratio was 57.9% only in patients with specific characteristic findings of ischemia in the ECG. Of the patients with a negative troponin value at the first test and in patients with a negative CGM, 87.1% were identified with a stenosis of less than 50% in the coronary angiogram. This ratio was 50% only in patients with a negative troponin value at the first test. The diagnostic accuracy of CGM was 88.2% in the patients with specific findings for ischemia in ECG and with a positive troponin value at the first test, however, it was 72.2% when ECG alone and the results of the first troponin tests were used in combination. By using the routine clinical criteria, of the study patients who were decided to undergo an early invasive intervention, 72.4% (n=247) of the patients were identified with a stenosis of more than 50% in the coronary angiogram, whereas, of the patients with positive CGM only, 80.2% (n=231) were identified with a stenosis of more than 50% in the coronary angiogram CONCLUSION: It is concluded that, because of its high sensitivity, cardiogoniometry (CGM) can be used as a screening test for the diagnosis of NSTE-ACS in patients presenting with chest pain and correlated complaints in the emergency departments, however CGM cannot be used in making the diagnosis of NSTE-ACS due to its lower specificity as 30.2% (N=16) of the CGM-negative patients were identified with a stenosis of more than 50% in coronary angiograms. Because 44.5% (n=53) of the patients diagnosed with UAP using the existing clinical criteria (n=119) were identified with a stenosis of less than 50% when they were referred to undergo a coronary angiogram and because CGM has a higher negative predictive value, it can be included in the diagnostic tests performed for discharging patients from the hospital. When CGM is used in conjunction with other diagnostic tests, it enhances the sensitivity and diagnostic accuracy of these tests.
Açıklama
Anahtar Kelimeler
Kardiyogonyometri, ST Elevasyonsuz Miyokard Enfarktüsü, Anstabil Anjina Pektoris, EKG, CGM, Cardiogoniometri, Myocardial Enfarction Without ST Elevation, Unstabil Angına Pectoris, ECG
