Bjurman Christian, Zywczyk Matteus, Lindahl Bertil, Carlsson Tobias, Johanson Per, Petzold Max, Holzmann Martin, Lx Fu Michael, Hammarsten Ola
Ola Hammarsten, MD, PhD, Professor Senior Physician Conjoint Professor, Newcastle University, Australia Institution of Biochemistry Department of clinical chemistry and transfusion medicine Bruna straket 16 Sahlgrenska academy at the University of Gothenburg SE 413 45 Gothenburg Sweden Email:
Cardiol J. 2017;24(6):612-622. doi: 10.5603/CJ.a2017.0079. Epub 2017 Jul 11.
The implementation of high-sensitivity cardiac troponin T (hs-cTnT) assays and a cutoff based on the 99th cTnT percentile in the evaluation of patients with suspected acute coronary syndrome has not been uniform due to uncertain effects on health benefits and utilization of limited resources.
Clinical and laboratory data from patients with chest pain or dyspnea at the emergency de¬partment (ED) were evaluated before (n = 20516) and after (n = 18485) the lowering of the hs-cTnT cutoff point from 40 ng/L to the 99th hs-cTnT percentile of 14 ng/L in February 2012. Myocardial infarction (MI) was diagnosed at the discretion of the attending clinicians responsible for the patient.
Following lowering of the hs-cTnT cutoff point fewer ED patients with chest pain or dyspnea as the principal complaint were analyzed with an hs-cTnT sample (81% vs. 72%, p < 0.001). Overall 30-day mortality was unaffected but increased among patients not analyzed with an hs-cTnT sample (5.3% vs. 7.6%, p < 0.001). The MI frequency was unchanged (4.0% vs. 3.9%, p = 0.72) whereas admission rates decreased (51% vs. 45%, p < 0.001) as well as hospital costs. Coronary angiographies were used more frequently (2.8% vs. 3.3%, p = 0.004) but with no corresponding change in coronary interventions.
At the participating hospital, lowering of the hs-cTnT cutoff point to the 99th percentile decreased admissions and hospital costs but did not result in any apparent prognostic or treatment benefits for the patients.
在疑似急性冠状动脉综合征患者的评估中，高敏心肌肌钙蛋白T（hs-cTnT）检测的实施以及基于第99百分位cTnT的临界值设定并不统一，原因是其对健康效益的影响以及有限资源利用的不确定性。
对急诊科（ED）因胸痛或呼吸困难就诊患者的临床和实验室数据在2012年2月hs-cTnT临界值从40 ng/L降至第99百分位的14 ng/L之前（n = 20516）和之后（n = 18485）进行评估。心肌梗死（MI）由负责该患者的主治医生自行诊断。
hs-cTnT临界值降低后，以胸痛或呼吸困难为主诉的急诊患者中接受hs-cTnT样本分析的人数减少（81%对72%，p < 0.001）。总体30天死亡率未受影响，但未接受hs-cTnT样本分析的患者死亡率增加（5.3%对7.6%，p < 0.001）。MI发生率未变（4.0%对3.9%，p = 0.72），而住院率下降（51%对45%，p < 0.001），医院成本也降低。冠状动脉造影检查使用更频繁（2.8%对3.3%，p = 0.004），但冠状动脉介入治疗无相应变化。
在参与研究的医院，将hs-cTnT临界值降至第99百分位可降低住院率和医院成本，但对患者未产生任何明显的预后或治疗效益。
