Department of Internal Medicine B, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport School of Medicine, Haifa, Israel.
Department of Internal Medicine B, Sanz Medical Center, Laniado Hospital, Netanya, Israel.
Am J Med. 2017 Oct;130(10):1205-1210. doi: 10.1016/j.amjmed.2017.03.032. Epub 2017 Apr 8.
Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes.
The objective of this study was to determine clinical utility, and downstream testing in patients with elevated troponin values but without chest pain or electrocardiographic changes.
We selected all patients aged 30-100 years hospitalized in cardiology and internal medicine departments from July 1, 2013 until July 31, 2016. We chose a subgroup of 723 consecutive subjects with elevated troponin values for chart review to determine the proportion of patients without chest pain or ischemic electrocardiographic changes, and resultant differential treatment and downstream testing. Clinical utility was defined as coronary artery interventions or treatment of life-threatening arrhythmias.
Troponin measurements were sent in 52.5% of all hospitalized patients (16,519/31,448), and were elevated in 29.9% (4938/16,519). Nearly two-thirds of the patients reviewed had neither chest pain nor ischemic electrocardiographic changes (63.3% [458/723]), and the elevated troponin values did not result in coronary artery interventions or treatment of life-threatening arrhythmias. The elevated troponin values were the sole reason for hospitalization in 2.0% (n = 9), for cardiac monitoring in 6.1% (n = 28), for cardiac consultations in 11.1% (n = 51), and for left heart catheterization in 0.7% (n = 3) of the patients.
Most of the elevated troponin test results were in patients without chest pain or ischemic electrocardiographic changes, had no clinical utility, and resulted in downstream testing.
尽管专家经常推荐，但在没有胸痛或缺血性心电图改变的患者中，升高的肌钙蛋白检测结果是否具有临床实用性尚不清楚。
本研究旨在确定肌钙蛋白升高但无胸痛或心电图改变的患者中该检测的临床实用性及下游检测结果。
我们选择了 2013 年 7 月 1 日至 2016 年 7 月 31 日期间心内科和内科住院的所有年龄在 30-100 岁的患者。我们选择了连续的 723 名肌钙蛋白升高患者的亚组进行图表审查，以确定无胸痛或缺血性心电图改变患者的比例，以及由此产生的差异治疗和下游检测结果。临床实用性定义为冠状动脉介入治疗或危及生命的心律失常的治疗。
肌钙蛋白检测在所有住院患者中的送检率为 52.5%（16519/31448），其中升高率为 29.9%（4938/16519）。在审查的患者中，近三分之二的患者既无胸痛也无缺血性心电图改变（63.3%[458/723]），且升高的肌钙蛋白值并未导致冠状动脉介入治疗或危及生命的心律失常的治疗。升高的肌钙蛋白值是导致 2.0%（n=9）患者住院、6.1%（n=28）患者进行心脏监测、11.1%（n=51）患者进行心脏咨询和 0.7%（n=3）患者进行左心导管检查的唯一原因。
大多数升高的肌钙蛋白检测结果出现在无胸痛或缺血性心电图改变的患者中，无临床实用性，导致下游检测。
