Clin Res Cardiol. 2014 Jan;103(1):29-40. doi: 10.1007/s00392-013-0619-5.
The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated.
Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS).
A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed.
A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7 %) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0 %. In contrast, 605 patients (27.3 %) underwent a coronary angiography without revascularization and had an ACS in 79.8 %. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4 %), pericarditis/myocarditis (4.5 %), decompensated congestive heart failure (3.7 %), Takotsubo cardiomyopathy (2.7 %), hypertensive crisis (2.4 %), and pulmonary embolism (0.3 %). During the 3-month followup, patients without revascularization had a higher mortality (12.1 vs. 4.5 %, p<0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1 %, p<0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization.
Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.
本分析旨在比较因胸痛就诊胸痛单元（CPU）并接受冠状动脉造影检查的肌钙蛋白阳性患者，以及无论是否随后进行血运重建的患者。评估主要诊断、疾病分布和短期预后。
胸痛单元越来越多地用于快速明确急性胸痛的病因，包括疑似急性冠状动脉综合征（ACS）的患者。
2008 年 12 月至 2011 年 4 月期间，前瞻性纳入了德国心脏病学会德国 CPU 注册研究中的 11753 例患者。入选所有肌钙蛋白升高且行冠状动脉造影的患者。出院后 3 个月进行随访。
共纳入 2218 例患者。2218 例患者中，1613 例肌钙蛋白阳性患者（72.7%）行冠状动脉造影检查且随后行 PCI 或 CABG，ACS 发生率为 96.0%。相比之下，605 例（27.3%）患者行冠状动脉造影检查但未进行血运重建，ACS 发生率为 79.8%。未行血运重建患者最常见的非冠状动脉诊断为急性心律失常（13.4%）、心包炎/心肌炎（4.5%）、充血性心力衰竭失代偿（3.7%）、心尖球形综合征（2.7%）、高血压危象（2.4%）和肺栓塞（0.3%）。在 3 个月随访期间，未行血运重建患者死亡率更高（12.1% vs. 4.5%，p<0.0001），这也是 MACCE 发生率较高（15.1% vs. 8.1%，p<0.001）的主要原因。ACS 患者中无论是否行血运重建，这一亚组分析均证实了上述结果。
因肌钙蛋白升高就诊 CPU 的患者大多患有 ACS，少数患者患有多种不同的疾病。ACS 患者和非 ACS 患者中无论是否行血运重建的患者短期预后均较差，表明这些患者比罪犯病变行血运重建的患者病情更严重。因此，需要进行充分的诊断评估并制定改善的治疗策略。
