Roos Andreas, Hellgren Anton, Rafatnia Farshid, Hammarsten Ola, Ljung Rickard, Carlsson Axel C, Holzmann Martin J
Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, NYU Lutheran Medical Center, Brooklyn, NY, USA.
Int J Cardiol. 2017 Apr 1;232:111-116. doi: 10.1016/j.ijcard.2017.01.044. Epub 2017 Jan 6.
Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI.
During January 1, 2011 to December 31, 2012, all patients >25years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI.
1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37-0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48-0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of ≤40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI.
Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.
在无心肌梗死（MI）的患者中，肌钙蛋白水平升高与死亡率增加相关。在一项观察性队列研究中，我们旨在评估与心肌梗死患者相比，高敏心肌肌钙蛋白T（hs-cTnT）水平升高且无心肌梗死的患者是如何接受检查和随访的。
在2011年1月1日至2012年12月31日期间，纳入卡罗林斯卡大学医院所有年龄大于25岁、有胸痛且hs-cTnT水平升高或患有心肌梗死的患者。我们计算了超声心动图、负荷试验和随访的风险比（RR）及95%置信区间（CI），并比较了有心肌梗死和无心肌梗死患者的用药情况。
纳入了1848例hs-cTnT水平升高但无心肌梗死的患者，其中871例（47%）既往无心脏病，以及667例心肌梗死患者。609例（33%）无心肌梗死的患者和580例（87%）有心肌梗死的患者接受了超声心动图检查（校正RR 0.42；95%CI，0.37 - 0.48）。计划对856例（46%）无心肌梗死的患者和611例（92%）有心肌梗死的患者进行随访（校正RR 0.54；95%CI，0.48 -
0.60）。在接受超声心动图检查的无心肌梗死且无心脏病的患者中，46例（14%）左心室射血分数≤40%，在负荷试验中，27例（37%）有与缺血相关的表现。无心肌梗死的患者中分别有266例（25%）和199例（17%）开始使用血小板抑制剂和他汀类药物，相比之下，有心肌梗死的患者中分别为424例（占93%）和416例（占86%）。
hs-cTnT水平升高且无心肌梗死的患者很少接受心脏病检测或随访，或开始使用可能预防未来心血管事件和死亡的心血管药物。
