Vafaie Mehrshad, Slagman Anna, Möckel Martin, Hamm Christian, Huber Kurt, Müller Christian, Vollert Jörn O, Blankenberg Stefan, Katus Hugo A, Liebetrau Christoph, Giannitsis Evangelos, Searle Julia
Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany.
Am J Med. 2016 Mar;129(3):274-82.e2. doi: 10.1016/j.amjmed.2015.10.016. Epub 2015 Oct 30.
The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department.
Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission.
Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536).
In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
急诊部门一直在探索改善疑似急性冠脉综合征患者安全早期出院的策略。这项心血管生物标志物（BIC）-8生物标志物子研究评估了急诊科低至中度风险疑似急性冠脉综合征患者中，检测下限（LoD）以下或以上的高敏肌钙蛋白T（hsTnT）的效用。
患者被分为hsTnT≥第99百分位数、处于第99百分位数和LoD之间或hsTnT不可检测（<LoD）。入院时测定hsTnT和 copeptin，copeptin的临界值为10 pmol/L。主要终点是入院后90天内的死亡和心肌梗死。
在882例有所有生物标志物结果的患者中，577例（65.4%）hsTnT水平可检测（≥LoD）。在hsTnT不可检测的305例患者（34.6%）中，90天内未发生心肌梗死或死亡。入院时hsTnT可检测（≥LoD但≤第99百分位数）的患者中, 90天内，copeptin阴性患者的联合终点发生率为1.5%（6/410），copeptin阳性患者为6.3%（6/96）（风险比4. /31）的copeptin阴性患者和15.4%（4/26）的copeptin阳性患者出现联合终点（风险比1.61；95%置信区间，0.36-7.17；P = 0.536）。
在低至中度风险疑似急性冠脉综合征患者中，入院时hsTnT值不可检测可实现安全出院，90天内无死亡或心肌梗死发生。
