Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city i...Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.展开更多
目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑...目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑瘫儿童康复提供更具针对性的综合方案。方法选取2022年10月至2023年12月温州医科大学附属第二医院收治的66例脑瘫儿童为研究对象,随机将其分为实验组和对照组,每组33例。实验组患儿接受基于ICF-CY的MACE康复体系综合康复干预,对照组患儿接受传统康复治疗;评估并比较两组患儿干预后的改良Ashworth量表评分、膝关节活动度、儿童功能独立性评定量表(functional independence measure for children,WeeFIM)评分、粗大运动功能评估量表(gross motor function measure,GMFM)和精细运动功能评估量表(fine motor function measure,FMFM)评分。结果干预后,两组患儿的改良Ashworth量表评分均显著低于本组干预前,膝关节活动度显著优于本组干预前,WeeFIM评分、GMFM评分和FMFM评分均显著高于本组干预前(P<0.05);实验组患儿的改良Ashworth量表评分显著低于对照组,膝关节活动度显著优于对照组,WeeFIM评分、GMFM和FMFM评分均显著高于对照组(P<0.05)。结论基于ICF-CY的MACE康复体系可有效改善脑瘫儿童的肌张力和关节活动度,增强功能独立性和运动功能。展开更多
Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
文摘Objective:To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events(MACEs)of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad,a city in western India.Methods:A prospective study was conducted on chest pain patients from January to December 2019.All adult patients with non-traumatic chest pain presenting to the emergency department were included,and their HEART and TIMI scores were evaluated.The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death.The receiver-operating characteristics(ROC)curve was used to determine the value of HEART and TIMI scores in predicting MACEs.Besides,the specificity,sensitivity,positive predictive value(PPV),and negative predictive value(NPV)of the two scores were assessed and compared.Results:A total of 350 patients were evaluated[mean age(55.03±16.6)years,56.6%of males].HEART score had the highest predictive value of MACEs with an area under the curve(AUC)of 0.98,followed by the TIMI score with an AUC of 0.92.HEART score had the highest specificity of 98.0%(95%CI:96.4%-99.6%),the sensitivity of 75.0%(95%CI:70.7%-79.3%),and PPV of 97.0%(95%CI:94.1%-99.9%)and NPV of 82.5%(95%CI:74.6%-90.4%)for low-risk patients.TIMI score had a specificity of 95.0%(95%CI:92.4%-97.6%),sensitivity of 75.0%(95%CI:69.4%-80.6%),PPV of 92.3%(95%CI:88.1%-96.5%)and NPV of 82.3%(95%CI:73.8%-90.8%)for low-risk patients.Conclusions:HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score.Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.
文摘目的探究基于《国际功能、残疾和健康分类(儿童和青少年版)》(international classification of functioning,disability and health for children and youth,ICF-CY)的MACE康复体系对儿童脑性瘫痪(以下简称脑瘫)功能改善的有效性,为脑瘫儿童康复提供更具针对性的综合方案。方法选取2022年10月至2023年12月温州医科大学附属第二医院收治的66例脑瘫儿童为研究对象,随机将其分为实验组和对照组,每组33例。实验组患儿接受基于ICF-CY的MACE康复体系综合康复干预,对照组患儿接受传统康复治疗;评估并比较两组患儿干预后的改良Ashworth量表评分、膝关节活动度、儿童功能独立性评定量表(functional independence measure for children,WeeFIM)评分、粗大运动功能评估量表(gross motor function measure,GMFM)和精细运动功能评估量表(fine motor function measure,FMFM)评分。结果干预后,两组患儿的改良Ashworth量表评分均显著低于本组干预前,膝关节活动度显著优于本组干预前,WeeFIM评分、GMFM评分和FMFM评分均显著高于本组干预前(P<0.05);实验组患儿的改良Ashworth量表评分显著低于对照组,膝关节活动度显著优于对照组,WeeFIM评分、GMFM和FMFM评分均显著高于对照组(P<0.05)。结论基于ICF-CY的MACE康复体系可有效改善脑瘫儿童的肌张力和关节活动度,增强功能独立性和运动功能。
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
