Acil servise göğüs ağrısı ile gelen düşük riskli hastaların tanımlanmasında kullanılan risk skorlarının karşılaştırılması
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2025
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Kırıkkale Üniversitesi, Sağlık Bilimleri Enstitüsü
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info:eu-repo/semantics/openAccess
Özet
Kan Z. Acil Servise Göğüs Ağrısı ile Gelen Düşük Riskli Hastaların Tanımlanmasında Kullanılan Risk Skorlarının Karşılaştırılması. Kırıkkale Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı (Uzmanlık Tezi). Kırıkkale, 2025. Giriş ve amaç: Göğüs ağrısı acil servise sık başvuru nedenleri arasında yer almaktadır. ABD'de yılda yaklaşık 6 ile 9 milyon hasta göğüs ağrısı şikayeti ile acil servise başvurmaktadır. Bugüne kadar yapılan çalışmalarda SVEAT ve HEART skorları göğüs ağrısı ile gelen hastaların risk tanımlanmasında başarılı sonuçlara ulaşmıştır. Bu çalışmanın amacı; acil servise göğüs ağrısı ile başvuran hastaların risk değerlendirmesinde kullanılan SVEAT ve HEART skorunun etkinliğini değerlendirmektir. Gereç ve yöntem: Bu prospektif çok merkezli gözlemsel çalışma 01/06/2024-31/11/2024 tarihleri arasında bir ilde bulunan primer perkütan koroner girişim yapan iki merkezde yapıldı. Çalışmaya beş dakikadan uzun süren göğüs ağrısı şikayeti ile başvuran ve aydınlatılmış onam veren 18 yaş ve üstü hastalar dahil edildi. Acil servise travma nedeniyle başvuran, gebe olan, gelişinde STEMI olarak değerlendirilen, taburculuk sonrası iletişim sağlanamayan ve başvuru anında yaşamsal fonksiyonu olmayan hastalar çalışmadan dışlandı. Hastalar major istenmeyen kardiyak olay (MACE) durumlarına göre gruplara ayırıldı ve analizleri yapıldı. Bulgular: Son analizlere toplam 704 hasta dahil edildi. Hastaların 157 (%22,3)'sinde MACE gözlendi. Başvuru anında (0. saat), 1. saat ve 2. saatte hesaplanan SVEAT skorunun Area Under the Curve (AUC) değerleri sırasıyla 0,954, 0,954 ve 0,955 olarak saptandı. HEART skorunun 0, 1 ve 2. saatte hesaplanan Area Under the Curve (AUC) değerleri sırasıyla 0,935, 0,937 ve 0,938 olarak saptandı. SVEAT skorunun 0, 1. ve 2. saatte hesaplanan MACE'ı öngörmedeki sensitivitesi sırasıyla %89, %89 ve %89 olarak tespit edildi. SVEAT skorunun 0, 1. ve 2. saatte hesaplanan MACE'ı öngörmedeki spesifisteleri %91, %91 ve %91 olarak tespit edildi. HEART skorunun 0, 1. ve 2. saatte hesaplanan MACE'ı öngörmedeki sensitivitesi sırasıyla %89, %91 ve %92 olarak tespit edildi. HEART skorunun 0, 1. ve 2. saatte hesaplanan MACE'ı öngörmedeki spesifisitesi sırasıyla %83, %83 ve %83 olarak tespit edildi. Sonuç: Acil servise göğüs ağrısı ile başvuran hastaların risk değerlendirmesinde 0,1 ve 2. saatte ölçülen SVEAT ve HEART skorları güvenle kullanılabilir. Ek olarak acil servise göğüs ağrısı ile başvuran hastalarda yaş, vital bulgular, komorbid hastalık varlığı ve troponin değerleri MACE ile ilişkili bulunmuştur. Anahtar Kelimeler: Göğüs ağrısı, SVEAT Skoru, HEART Skoru, düşük riskli hasta, akut koroner sendrom
Kan Z. Comparison of Risk Scores Identifying Low-Risk Patients Presenting to the Emergency Department with Chest Pain. Kırıkkale University Faculty of Medicine, Department of Emergency Medicine (Thesis). Kırıkkale, Türkiye, 2025. Introduction and aim: Chest pain is a common reason for emergency department (ED) visits. Approximately 6 to 9 million patients in the United States visit the ED with chest pain annually. In studies conducted to date, SVEAT and HEART scores have successfully identified the risk of patients presenting with chest pain. This study aims to evaluate the effectiveness of SVEAT and HEART scores used in risk assessment of patients presenting with chest pain. Materials and methods: This prospective multicenter observational study was conducted between 01/06/2024 and 31/11/2024 in two centers performing primary percutaneous coronary intervention in a province. Patients aged 18 and over who presented with chest pain lasting longer than five minutes and gave informed consent were included in the study. Patients who presented to the ED due to trauma, were pregnant, were evaluated as STEMI upon arrival, could not be communicated with after discharge, and had no vital functions at the time of presentation were excluded. Patients were divided into groups according to their major adverse cardiac event (MACE) status, and their analyses were performed. Results: A total of 704 patients were included in the final analyses. MACE was observed in 157 (22.3%) of the patients. The Area Under the Curve (AUC) values of the SVEAT score calculated at the time of presentation (0th hour), 1st hour, and 2nd hour were determined as 0.954, 0.954, and 0.955, respectively. The Area Under the Curve (AUC) values of the HEART score calculated at 0, 1st, and 2nd hours were determined as 0.935, 0.937, and 0.938, respectively. The sensitivity of the SVEAT score in predicting MACE calculated at 0, 1st, and 2nd hours was determined as 89%, 89% and 89%, respectively. The specificities of SVEAT score in predicting MACE calculated at 0, 1 and 2 hours were determined as 91%, 91% and 91%. The sensitivity of HEART score in predicting MACE calculated at 0, 1 and 2 hours was determined as 89%, 91% and 92%, respectively. The specificity of HEART score in predicting MACE calculated at 0, 1 and 2 hours was determined as 83%, 83% and 83%, respectively. Conclusion: SVEAT and HEART scores measured at 0, 1st, and 2nd hours can be used safely in the risk assessment of patients presenting to the emergency department with chest pain. In addition, age, vital signs, presence of comorbid diseases, and troponin values were associated with MACE in patients presenting to the emergency department with chest pain. Keywords: Chest pain, SVEAT score, HEART score, low-risk patient, acute coronary syndrome
Kan Z. Comparison of Risk Scores Identifying Low-Risk Patients Presenting to the Emergency Department with Chest Pain. Kırıkkale University Faculty of Medicine, Department of Emergency Medicine (Thesis). Kırıkkale, Türkiye, 2025. Introduction and aim: Chest pain is a common reason for emergency department (ED) visits. Approximately 6 to 9 million patients in the United States visit the ED with chest pain annually. In studies conducted to date, SVEAT and HEART scores have successfully identified the risk of patients presenting with chest pain. This study aims to evaluate the effectiveness of SVEAT and HEART scores used in risk assessment of patients presenting with chest pain. Materials and methods: This prospective multicenter observational study was conducted between 01/06/2024 and 31/11/2024 in two centers performing primary percutaneous coronary intervention in a province. Patients aged 18 and over who presented with chest pain lasting longer than five minutes and gave informed consent were included in the study. Patients who presented to the ED due to trauma, were pregnant, were evaluated as STEMI upon arrival, could not be communicated with after discharge, and had no vital functions at the time of presentation were excluded. Patients were divided into groups according to their major adverse cardiac event (MACE) status, and their analyses were performed. Results: A total of 704 patients were included in the final analyses. MACE was observed in 157 (22.3%) of the patients. The Area Under the Curve (AUC) values of the SVEAT score calculated at the time of presentation (0th hour), 1st hour, and 2nd hour were determined as 0.954, 0.954, and 0.955, respectively. The Area Under the Curve (AUC) values of the HEART score calculated at 0, 1st, and 2nd hours were determined as 0.935, 0.937, and 0.938, respectively. The sensitivity of the SVEAT score in predicting MACE calculated at 0, 1st, and 2nd hours was determined as 89%, 89% and 89%, respectively. The specificities of SVEAT score in predicting MACE calculated at 0, 1 and 2 hours were determined as 91%, 91% and 91%. The sensitivity of HEART score in predicting MACE calculated at 0, 1 and 2 hours was determined as 89%, 91% and 92%, respectively. The specificity of HEART score in predicting MACE calculated at 0, 1 and 2 hours was determined as 83%, 83% and 83%, respectively. Conclusion: SVEAT and HEART scores measured at 0, 1st, and 2nd hours can be used safely in the risk assessment of patients presenting to the emergency department with chest pain. In addition, age, vital signs, presence of comorbid diseases, and troponin values were associated with MACE in patients presenting to the emergency department with chest pain. Keywords: Chest pain, SVEAT score, HEART score, low-risk patient, acute coronary syndrome
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KAN, Z. (2025). Acil servise göğüs ağrısı ile gelen düşük riskli hastaların tanımlanmasında kullanılan risk skorlarının karşılaştırılması (Ph.D. dissertation).
