Utilidad de las escalas Heart y Timi en la evaluación de dolor toráxico como predictor de eventos cardiovasculares mayores en emergencia
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2023
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: El paciente con dolor torácico que acude a una sala de emergencia es todo un
reto diagnóstico, ya que este suele ser un síntoma de un síndrome coronario agudo (SCA),
sin embargo, un porcentaje importante de estos casos no lo será. Diferenciar a los verdaderos
positivos es de vital importancia ya que esto permitirá brindar una atención efectiva, así como
temprana ayuda para prevenir y reducir en un importante porcentaje la presencia de eventos
cardiovasculares agudos mayores (ECAM).
Objetivos: Determinar si la escala HEART tiene mejor capacidad pronostica que la escala
TIMI para predecir un ECAM a 6 semanas de evolución en pacientes con dolor torácico
atendidos en la sala de emergencia.
Metodología: Se realizará un estudio de cohorte en el que se incluirán de manera no aleatoria
por conveniencia 78 pacientes con dolor torácico que sean atendidos en el servicio de
urgencias del hospital Abel Gilbert Pontón que posean un electrocardiograma, con al menos
2 valoraciones de enzimas y seguimiento mínimo 6 semanas. Se excluyen pacientes que
fueron trasladados a otras instituciones hospitalarias, y pacientes con síndrome coronario
agudo establecido. 39 pacientes serán valorados con la herramienta pronostica HEART y 39
con la herramienta TIMI. El punto final a valorar será la presencia de ECAM. También se
establecerá el rendimiento diagnóstico.
Resultados Esperados: Se espera comprobar que con HEART se puede reducir el número
de ECAM a 5.2% a las 6 semanas de evolución.
Background: The patient with chest pain who comes to the emergency room is a patient that offers a challenge since this is usually a symptom of acute coronary syndrome (ACS), but a significant percentage will not be. Differentiating true positives helps reduce the occurrence of major acute cardiovascular events (MACE) Objectives: To determine if the HEART scale has a better prognostic capacity than TIMI to predict ECAM at 6 weeks in patients with chest pain seen in the emergency room. Methodology: A cross-sectional study was carried out with 535 consecutive patients chosen for convenience, with chest pain, treated in the emergency department of the Abel Gilbert Pontón Hospital, Guayaquil. They must have had an electrocardiogram, at least 2 enzyme evaluations, a minimum follow-up of 6 weeks. Patients transferred to other institutions and patients with established ACS were excluded. Patients were to be evaluated with TIMI and HEART. The end point to be evaluated was the presence of ECAM to establish the diagnostic yield. Results: 56.6% of the patients were men and 43.4% women, 35.7% were ≥65 years of age. The prevalence of DCM was 8.2%. With HEART, correct diagnoses were 39.8%; Sensitivity 97%, Specificity 34.6%, PPV 11.8%, NPV 99.4%, LH+ 1.9%, LH- 0.1. With TIMI, the percentage of correct diagnoses was 66.4%. sensitivity 90.9%, specificity 64.2%, PPV 18.5%, NPV 98.7%, LH+ 2.5, LH- 0.1 Conclusions: The two tests have a better performance, ruling out pictures of patients without ECAM at 6 weeks, not confirming them, however, TIMI achieves a greater number of correct diagnoses.
Background: The patient with chest pain who comes to the emergency room is a patient that offers a challenge since this is usually a symptom of acute coronary syndrome (ACS), but a significant percentage will not be. Differentiating true positives helps reduce the occurrence of major acute cardiovascular events (MACE) Objectives: To determine if the HEART scale has a better prognostic capacity than TIMI to predict ECAM at 6 weeks in patients with chest pain seen in the emergency room. Methodology: A cross-sectional study was carried out with 535 consecutive patients chosen for convenience, with chest pain, treated in the emergency department of the Abel Gilbert Pontón Hospital, Guayaquil. They must have had an electrocardiogram, at least 2 enzyme evaluations, a minimum follow-up of 6 weeks. Patients transferred to other institutions and patients with established ACS were excluded. Patients were to be evaluated with TIMI and HEART. The end point to be evaluated was the presence of ECAM to establish the diagnostic yield. Results: 56.6% of the patients were men and 43.4% women, 35.7% were ≥65 years of age. The prevalence of DCM was 8.2%. With HEART, correct diagnoses were 39.8%; Sensitivity 97%, Specificity 34.6%, PPV 11.8%, NPV 99.4%, LH+ 1.9%, LH- 0.1. With TIMI, the percentage of correct diagnoses was 66.4%. sensitivity 90.9%, specificity 64.2%, PPV 18.5%, NPV 98.7%, LH+ 2.5, LH- 0.1 Conclusions: The two tests have a better performance, ruling out pictures of patients without ECAM at 6 weeks, not confirming them, however, TIMI achieves a greater number of correct diagnoses.
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DOLOR EN EL PECHO, ENFERMEDADES CARDIOVASCULARES, ESCALA HEART, ESCALA TIMI, URGENCIAS MEDICAS, HOSPITAL DE ESPECIALIDADES GUAYAQUIL DR. ABEL GILBERT PONTON, CANTON GUAYAQUIL, ECUADOR