INVESTIGATING THE DIAGNOSTIC VALUE OF CARDIOGONIOMETRY IN IDENTIFYING PATIENTS WITH NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (NSTEMI) AND UNSTABLE ANGINA PECTORIS (UAP) IN THE EMERGENCY DEPARTMENT
Project no. 40 · Status: Kapanmış · 2016
Summary
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: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 9 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. 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.