Meigher Stephen, Thode Henry C, Peacock W Frank, Bock Jay L, Gruberg Louis, Singer Adam J
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
Department of Emergency Medicine, Baylor College of Medicine, Houston, TX.
Acad Emerg Med. 2016 Nov;23(11):1267-1273. doi: 10.1111/acem.13033. Epub 2016 Nov 3.
Cardiac troponins (cTn) are structural components of myocardial cells and are expressed almost exclusively in the heart. Elevated cTn levels indicate myocardial cell damage/death but not reflect the underlying etiology. The third universal definition of myocardial infarction (MI) differentiates MI into various types. Type 1 (T1MI) is due to plaque rupture with thrombus, while type 2 (T2MI) is a result of a supply:demand mismatch. Non-MI cTn elevations are also common. We determined the causes of elevated cTn in a tertiary care emergency department (ED) and the associated in-hospital mortality.
We performed a structured, retrospective review of all consecutive adult ED patients with elevated troponin I (defined as > 99th percentile of the normal population, as run on the ADVIA Centaur platform; Siemens USA) during 1 year. Causes of elevated cTn were classified based on the third universal definitions. Comparisons between groups were performed using chi-square and Mann-Whitney U-tests.
Of 96,612 ED patients presenting from May 2012 to April 2013, a total of 13,502 (14%) had cTn measured, of which 1,310 (9.7%) were elevated. Of these, 340 (26.5%, 95% confidence interval [CI], 24.2% to 29.0%) were T1MI, 452 (35.2%, 95% CI = 32.7% to 37.9%) T2MI, 458 (35.7%, 95% CI = 33.1% to 38.4%) multifactorial, and 33 (2.5%, 95% CI = 1.8% to 3.5%) due to nonischemic injury. Non-T1MI patients were slightly older, more likely female, and had higher blood urea nitrogen and creatinine. Comorbidities were more common in non-T1MI while cardiac risk factors were more common in T1MI. Non-T1MI patients were less likely to have diagnostic ECGs and had lower initial and subsequent cTn levels. In-hospital mortality rates were similarly high for T1MI and non-T1MI (11% [95% CI = 8% to 15%] vs. 10% [95% CI = 8% to 12%], p = 0.48).
Of all ED patients with elevated cTn, ~75% have a non-T1MI. The mortality of patients with non-T1MI is similar to the mortality in patients with T1MI.
心肌肌钙蛋白（cTn）是心肌细胞的结构成分，几乎仅在心脏中表达。cTn水平升高表明心肌细胞损伤/死亡，但不能反映潜在病因。心肌梗死（MI）的第三个通用定义将MI分为多种类型。1型（T1MI）是由斑块破裂伴血栓形成所致，而2型（T2MI）是供需不匹配的结果。非MI的cTn升高也很常见。我们确定了三级医疗急诊科（ED）中cTn升高的原因以及相关的院内死亡率。
我们对1年内所有连续的肌钙蛋白I升高（定义为在ADVIA Centaur平台上检测，高于正常人群第99百分位数；美国西门子公司）的成年ED患者进行了结构化回顾性研究。根据第三个通用定义对cTn升高的原因进行分类。使用卡方检验和Mann-Whitney U检验进行组间比较。
在2012年5月至2013年4月就诊的96,612例ED患者中，共有13,502例（14%）检测了cTn，其中1,310例（9.7%）升高。其中，340例（26.5%，95%置信区间[CI]，24.2%至29.0%）为T1MI，452例（35.2%，95% CI = 32.7%至37.9%）为T2MI，458例（35.7%，95% CI = 33.1%至38.4%）为多因素所致，33例（2.5%，95% CI = 1.8%至3.5%）为非缺血性损伤所致。非T1MI患者年龄稍大，女性更常见，血尿素氮和肌酐更高。合并症在非T1MI中更常见，而心脏危险因素在T1MI中更常见。非T1MI患者进行诊断性心电图检查的可能性较小，初始及后续cTn水平较低。T1MI和非T1MI的院内死亡率同样高（11% [95% CI = 8%至15%] 对 10% [95% CI = 8%至12%]，p = 0.48）。
在所有cTn升高的ED患者中，约75%为非T1MI。非T1MI患者的死亡率与T1MI患者的死亡率相似。
