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Evaluación del algoritmo de la Sociedad Europea de Cardiología de dolor torácico en pacientes con diabetes mellitus;
Performance of the European Society of Cardiology Algorithm for the Assessment of Chest Pain in Patients with Diabetes Mellitus

Creators:Cortés, Marcia, Duczynski, María Paula, Busch, Germán, Resi, Silvana, Ariznavarreta, Paula, Borda, Maité, Costabel, Juan Pablo
2021-02-11

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Descripción

Introducción: Dado que los pacientes con diabetes tienen habitualmente niveles de troponina más elevados que la poblacióngeneral, nos propusimos evaluar el comportamiento del algoritmo de la Sociedad Europea de Cardiología que utiliza la mediciónde troponina de alta sensibilidad al ingreso y 1 hora después en estos pacientes.Material y métodos: Se evaluaron 1140 pacientes que consultaron por dolor torácico con electrocardiograma sin supradesniveldel segmento ST. El algoritmo estratifica los pacientes en tres grupos de riesgo: “externar”, “observar” e “internar”. Se valoróel comportamiento del algoritmo para el evento infarto a 30 d.Resultados: En total, 124 pacientes (10,8%) tenían diabetes. Ninguno de los clasificados como “externar” (40,3%) presentóinfarto a 30 días. En los “internar” (23,4%), el evento se produjo en el 82,8%, mientras que en el grupo “observar” (36,3%),en el 6,8%. La sensibilidad y el valor predictivo negativo fueron similares entre pacientes con diabetes y sin esta (100% vs.98,5% p = 0,865 y 100% vs. 99,8% p = 0,44), pero la proporción de pacientes para “externar” fue menor en diabéticos (40,3%vs. 72,1%, p &lt;0,001). En cuanto a la precisión para “internar” pacientes, la especificidad fue menor en diabéticos, pero elvalor predictivo positivo fue mayor (90,9% vs. 97,2%, p &lt;0,001 y 83% vs. 76%, p &lt;0,001). La proporción de pacientes para“internar” fue mayor en diabéticos (23% vs. 8,6%, p &lt;0,001).Conclusiones: El uso del algoritmo en pacientes con diabetes mostró una alta sensibilidad y un alto valor predictivo negativopara “externar” comparable a la población general. En cuanto al grupo “internar”, presentó menor especificidad, pero altovalor predictivo positivo. Esto lo transforma en una útil herramienta para la práctica diaria.

Background: Patients with diabetes usually have higher troponin levels than the general population.Objective: The aim of our study was to evaluate the performance of the European Society of Cardiology algorithm which useshigh sensitivity cardiac troponin levels on admission and after 1 hour in these patients.Methods: A total of 1,140 patients with chest pain and ECG without ST-segment elevation were evaluated. The algorithmstratifies patients in three risk groups: rule-out, observe and rule-in. We evaluated the performance of the algorithm to predictmyocardial infarction at 30 days.Results: A total of 124 patients (10.8%) had diabetes. None of the patients in the rule-out group (40.3%) presented myocardialinfarction at 30 days. In the rule-in group (23.4%), the event occurred in 82.8% of cases and in 6.8% in the observe group(36.3%). Sensitivity and negative predictive value were similar in patients with and without diabetes (100% vs. 98.5%, p= 0.865and 100% vs. 99.8%, p=0.44), but the proportion of patients in the rule-out group was lower in diabetics (40.3% vs. 72.1%,p&lt;0.001). The accuracy of the algorithm to rule in patients was evaluated by its specificity which was lower in diabetics, butthe positive predictive value was greater (90.9% vs. 97.2%, p&lt;0.001 and 83% vs. 76%, p&lt;0.001). The proportion of patientsin the rule-in group was higher in diabetics (23% vs. 8.6%, p&lt;0.001).Conclusion: The use of the algorithm in patients with diabetes revealed high sensitivity and negative predictive value to ruleout, which was similar to that of the general population. Regarding the rule-in group, it had lower specificity but high positivepredictive value. This performance makes the algorithm a useful tool for daily practice.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 88, No 6 (2020); 502, Argentine Journal of Cardiology; Vol 88, No 6 (2020); 502

Citación

Cortés, Marcia et al., “Evaluación del algoritmo de la Sociedad Europea de Cardiología de dolor torácico en pacientes con diabetes mellitus,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/9766.

Dublin Core

Materia

Autor

Cortés, Marcia
Duczynski, María Paula
Busch, Germán
Resi, Silvana
Ariznavarreta, Paula
Borda, Maité
Costabel, Juan Pablo

Fuente

Revista Argentina de Cardiología; Vol 88, No 6 (2020); 502
Argentine Journal of Cardiology; Vol 88, No 6 (2020); 502

Editor

Sociedad Argentina de Cardiología

Fecha

2021-02-11

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

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spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion