The American College of Cardiology (ACC) recently published an Expert Consensus Decision Pathway for chest pain. The purpose of this study was to validate the ACC Pathway in a multisite U.S. cohort. An observational cohort study of adults with possible acute coronary syndrome was conducted. Patients were accrued from 5 U.S. Emergency Departments (November 1, 2020, to July 31, 2022). ECGs and 0- and 2-hour high-sensitivity troponin (Beckman Coulter) measures were used to stratify patients according to the ACC Pathway. The primary safety outcome was 30-day all-cause death or myocardial infarction (MI). Efficacy was defined as the proportion stratified to the rule-out zone. Negative predictive value for 30-day death or MI was assessed among the whole cohort and in a subgroup of patients with coronary artery disease (CAD) (prior MI, revascularization, or ≥70% coronary stenosis). ACC Pathway assessments were complete in 14,395 patients, of whom 51.7% (7,437 of 14,395) were women with a median age of 56 years (Q1-Q3: 44-68 years). Known CAD was present in 23.5% (3,386 of 14,395) and 30-day death or MI occurred in 8.1% (1,168 of 14,395). The ACC Pathway had an efficacy of 48.1% (95% CI: 47.3%-49.0%). Among patients in the rule-out zone, 0.3% (22 of 6,930) had death or MI at 30 days, yielding a negative predictive value of 99.7% (95% CI: 99.5%-99.8%). In patients with known CAD, 20.0% (676 of 3,386) were classified to the rule-out zone, of whom 1.5% (10 of 676) had death or MI. The ACC expert consensus decision pathway was safe and efficacious. However, it may not be safe for use among patients with known CAD.

中文翻译：

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针对胸痛患者的 ACC 专家共识决策路径验证

美国心脏病学会 (ACC) 最近发布了胸痛专家共识决策路径。本研究的目的是在美国多地点队列中验证 ACC 途径。对可能患有急性冠状动脉综合征的成年人进行了一项观察性队列研究。患者来自美国 5 个急诊科（2020 年 11 月 1 日至 2022 年 7 月 31 日）。 ECG 以及 0 小时和 2 小时高敏肌钙蛋白 (Beckman Coulter) 测量用于根据 ACC 路径对患者进行分层。主要安全性结局是 30 天全因死亡或心肌梗塞 (MI)。功效被定义为分层至排除区的比例。在整个队列和冠状动脉疾病 (CAD) 患者亚组（既往 MI、血运重建或≥70% 冠状动脉狭窄）中评估了 30 天死亡或 MI 的阴性预测值。 14,395 名患者完成了 ACC 路径评估，其中 51.7%（14,395 名患者中的 7,437 名）是女性，中位年龄为 56 岁（第一季度至第三季度：44-68 岁）。 23.5% 的人（14,395 人中的 3,386 人）患有已知的 CAD，8.1% 的人（14,395 人中的 1,168 人）发生 30 天死亡或心肌梗死。 ACC 途径的疗效为 48.1%（95% CI：47.3%-49.0%）。在排除区的患者中，0.3%（6,930 名患者中的 22 名）在 30 天时死亡或心肌梗死，阴性预测值为 99.7%（95% CI：99.5%-99.8%）。在已知患有 CAD 的患者中，20.0%（3,386 名患者中的 676 名）被归为排除区，其中 1.5%（676 名患者中的 10 名）死亡或心肌梗塞。 ACC专家共识决策路径安全有效。然而，对于患有已知 CAD 的患者来说，使用它可能不安全。