Functional Area of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
J Am Coll Cardiol. 2017 May 30;69(21):2622-2630. doi: 10.1016/j.jacc.2017.03.586.
Most patients with chest pain are discharged from the emergency department (ED) with the diagnosis "unspecified chest pain." It is unknown if evaluation with a high-sensitivity troponin T (hsTnT) assay affects prognosis in this large population.
The aim was to investigate whether the introduction of an hsTnT assay is associated with reduced incidence of major adverse cardiac events (MACEs) and cardiovascular (CV) risk profile in patients with chest pain discharged from the ED.
The study included 65,696 patients with "unspecified chest pain" discharged from 16 Swedish hospital EDs between 2006 and 2013 in which an hsTnT assay was introduced as the clinical routine. Patients evaluated with a conventional and an hsTnT assay were compared regarding the occurrence of 30-day MACE and CV risk profile based on information from national registries. Patients directly discharged and those discharged after an initial admission were analyzed separately.
Fewer directly discharged patients experienced a MACE when evaluated with an hsTnT compared with a conventional assay (0.6% vs. 0.9%; odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.57 to 0.83). In contrast, more patients discharged after an initial admission experienced a MACE when evaluated with an hsTnT (7.2% vs. 3.4%; OR: 2.18; 95% CI: 1.76 to 2.72). Admitted patients had a higher general CV risk profile when evaluated with hsTnT, whereas directly discharged patients had a lower general CV risk profile with the same test.
Patients directly discharged from the ED with unspecified chest pain experienced fewer MACEs and had a better risk profile when evaluated with hsTnT. Our findings suggest that more true at-risk patients were identified and admitted. The implementation of hsTnT assays in Swedish hospitals has improved evaluations in the ED.
大多数胸痛患者从急诊科（ED）出院时的诊断为“未特指胸痛”。目前尚不清楚在这个庞大的人群中，使用高敏肌钙蛋白 T（hsTnT）检测是否会影响预后。
本研究旨在探讨在急诊科（ED）因“未特指胸痛”而出院的患者中，引入 hsTnT 检测是否与降低主要不良心脏事件（MACE）和心血管（CV）风险谱的发生率相关。
该研究纳入了 2006 年至 2013 年间在瑞典 16 家医院 ED 中因“未特指胸痛”出院的 65696 例患者。在这些患者中，hsTnT 检测被引入临床常规检测。比较了使用传统检测和 hsTnT 检测的患者在 30 天内发生 MACE 和 CV 风险谱的情况，其信息来自国家登记处。分别分析了直接出院的患者和初始入院后出院的患者。
与传统检测相比，直接出院的患者使用 hsTnT 检测时，发生 MACE 的患者比例较低（0.6% vs. 0.9%；比值比 [OR]：0.7；95%置信区间 [CI]：0.57 至 0.83）。相反，初始入院后出院的患者中，使用 hsTnT 检测时发生 MACE 的患者比例更高（7.2% vs. 3.4%；OR：2.18；95% CI：1.76 至 2.72）。入院患者使用 hsTnT 检测时，整体 CV 风险谱更高，而直接出院患者使用相同检测时，整体 CV 风险谱更低。
直接从 ED 出院的“未特指胸痛”患者，使用 hsTnT 检测时，MACE 发生率更低，风险谱更好。我们的研究结果表明，更多的高危患者得到了识别和收治。瑞典医院实施 hsTnT 检测后，改善了 ED 的评估。
