摘要目的:对比3种快速危险分层方案：温哥华胸痛诊断流程、TRUST加速诊断路径及EDACS加速诊断路径快速评估急诊胸痛患者的能力。方法:收集2017年1月1日0时～2017年2月1日0时就诊于天津医科大学总医院急诊疑似急性冠脉综合征的胸痛患者，按温哥华胸痛诊断流程、TRUST加速诊断路径及EDACS加速诊断路径对患者进行危险分层。终点事件为30 d内发生急性心肌梗死人数。结果:本研究共纳入134例患者，TRUST加速诊断路径共筛选低危患者57例，30 d内随访结果出现急性心肌梗死1例，鉴别低危胸痛的敏感度为83.3%，特异度43.8%，阴性预测值98.2%；EDACS加速诊断路径筛选低危患者51例，30 d内随访结果未发现急性心肌梗死病例，鉴别低危胸痛的敏感度为100%，特异度39.8%，阴性预测值100%；温哥华胸痛诊断流程共筛选低危患者24例，30 d内随访结果未发现急性心肌梗死病例，鉴别低危胸痛的敏感度为100%，特异度18.8%，阴性预测值100%。结论:快速危险分层方案有利于急性胸痛低危患者早期安全离院。EDACS加速诊断路径筛选低危患者比例>30%，且鉴别低危胸痛敏感度≥98%，阴性预测值≥99.5%。

abstractsObjective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.