Feasibility of Clinical Application in Hierarchical Diagnosis of Patients with Acute Coronary Syndrome in Emergency Cases

YIN Hong-jun; DONG Hui; LIU Jie; JIN Ai-chun; JIANG Zhi-feng; LI Shu; LIU Fu-jun

Abstract：Objective To explore the feasibility of hierarchical diagnosis for patients with acute coronary syndrome (ACS) in order to improve the diagnostic ability of ACS in emergency department (ED). Methods A total of 288 patients with chest pain or equivalent symptom from March to August 2013 were divided into ACS group (n = 192) and non-ACS group (n = 96) according to hierarchical diagnostic flowsheet. The general conditions, definite diagnostic outcomes and clinical turn-over by following up in the two groups were observed, and sensitivity and specificity of diagnostic flowsheet and standard using hierarchical diagnosis were analyzed. Results The differences in gender and symptom occurrence time in the two groups were statistically significant (P < 0. 05), but the difference in ages was not statistically significant (P > 0. 05). A total of 173 pa-tients were confirmed with having the ACS by coronary arteriongraphy in ACS group, and 3 patients were confirmed with having the ACS in non-ACS group. The accordance rate of preliminary diagnosis in ACS group was 90. 1% (173 / 192), while the rate in non-ACS group was 96. 9% (93 / 96). The sensitivity was 98. 3% , and specificity was 83. 0% . Two patients died in hospital in ACS group, but no one died in non-ACS group with follow-up for 30 d. Conclusion ACS hierarchical diagnosis in patients with chest pain or equivalent symptom can achieve preliminary ACS early diagnosis and standardized treatment in order to reduce misdiagnosis rate and avoid excessive therapy.