在初级保健中，使用心肌肌钙蛋白检测进行急性冠状动脉综合征的诊断。

Cardiac troponin testing for diagnosis of acute coronary syndromes in primary care.

机构信息

University of Western Australia, Perth, WA

University of Western Australia, Perth, WA.

出版信息

Med J Aust. 2015 Oct 19;203(8):336. doi: 10.5694/mja14.01154.

DOI:10.5694/mja14.01154

PMID:26465699

Abstract

OBJECTIVE

To examine the use of cardiac troponin (cTn) testing for acute coronary syndrome (ACS) diagnosis in primary care.

DESIGN AND SETTING

Prospective cohort study; general practitioner-initiated cTn tests conducted from 24 September 2009 to 3 September 2010 in Perth, Western Australia. Patient outcomes were obtained from linked data sources for up to 12 months after the final test. Clinical information and outcomes were compared with data from emergency department patients with ACS symptoms.

PARTICIPANTS

369 patients with samples collected at community laboratories. Requesting GPs provided the clinical context for testing.

MAIN OUTCOME MEASURES

Cardiovascular risk status, symptoms prompting cTn testing; estimated ACS likelihood and referral decision before and after testing; result turnaround time; hospital presentations, procedures and mortality.

RESULTS

Of the 328 GPs who received a survey request, 124 (37.8%) responded. 122 of 124 test results (98.4%) were negative. Based on clinical risk factors, 71 of 104 patients (68.2%) were at high or intermediate risk of ACS. 69 of 124 patients (55.6%) had typical ischaemic pain and 62 of 124 patients (50.0%) were tested within 48 hours of symptom onset (23.4% within 12 hours, with no serial testing). Test results affected GPs' estimation of ACS likelihood (P < 0.01) but not their referral decisions (P = 0.23). 94 of 355 patients (26.5%) presented to hospital with cardiovascular symptoms or diagnoses during follow-up; 27 of 355 patients (7.6%) had at least one ACS, 13 of 255 (3.7%) within 30 days of testing.

CONCLUSIONS

GP-initiated cTn testing involves patients at high risk of ACS. ACS and associated adverse outcomes can occur in patients undergoing testing, even when the cTn test result is negative. Potential gaps exist in physicians' understanding of the limitations of cTn testing, and cTn test results have minimal influence on their management of patients. GPs may benefit from guidance about ordering cTn testing.

摘要

目的

探讨在初级保健中使用心脏肌钙蛋白（cTn）检测进行急性冠状动脉综合征（ACS）诊断的情况。

设计和设置

前瞻性队列研究；2009 年 9 月 24 日至 2010 年 9 月 3 日期间，在澳大利亚西部珀斯的全科医生启动 cTn 检测。通过相关数据来源，在最后一次检测后长达 12 个月的时间内获得患者的结局数据。比较了有 ACS 症状的急诊科患者的临床信息和结局。

参与者

369 名在社区实验室采集样本的患者。要求检测的全科医生提供了检测的临床背景。

主要观察指标

心血管风险状况、提示 cTn 检测的症状；检测前后对 ACS 可能性和转诊决策的估计；检测结果周转时间；住院治疗、操作和死亡率。

结果

在收到调查请求的 328 名全科医生中，有 124 名（37.8%）做出了回应。124 份检测结果中的 122 份（98.4%）为阴性。根据临床危险因素，104 名患者中有 71 名（68.2%）为 ACS 的高危或中危人群。124 名患者中有 69 名（55.6%）有典型的缺血性疼痛，124 名患者中有 62 名（50.0%）在症状发作后 48 小时内接受检测（23.4%在 12 小时内，无连续检测）。检测结果影响了全科医生对 ACS 可能性的估计（P <0.01），但对转诊决策没有影响（P =0.23）。在随访期间，355 名患者中有 94 名（26.5%）因心血管症状或诊断而就诊；355 名患者中有 27 名（7.6%）至少有一次 ACS，其中 255 名患者中有 13 名（3.7%）在检测后 30 天内发生 ACS。