Röttger E, de Vries-Spithoven S, Reitsma J B, Limburg A, van Ofwegen-Hanekamp C E E, Hoes A W, Poldervaart J M
From the *Department of Emergency Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands; †Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands; ‡Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands; and §Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands.
Crit Pathw Cardiol. 2017 Dec;16(4):129-134. doi: 10.1097/HPC.0000000000000135.
The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice.
Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands). Hs-cTnT was measured at presentation (T0) and 1-1.5 hours after T0 (T1). Patients with a first troponin (T0) ≥ 0.012 ug/l were excluded. Primary endpoint was the 6-week occurrence of major adverse cardiac events (MACEs), defined as unstable angina, acute myocardial infarction (AMI), percutaneous coronary intervention, significant stenosis managed conservatively, coronary artery bypass grafting, and death.
Of the 374 analyzed patients, 16 patients (4.3%) developed 35 MACE. Of these 16 patients with endpoints, 3 were primarily discharged with noncardiac chest pain but returned within 6 weeks with unstable angina. Importantly, no patients experienced an AMI or died during follow-up.
No AMIs or deaths occurred after introducing the 1-hour hs-cTnT protocol to rule-out ACS in chest pain patients, but other MACE such as unstable angina occurred. Our results suggest the protocol is safe to implement in the ED in The Netherlands.
1小时排除高敏心肌肌钙蛋白T方案（hs-cTnT），即在首次检测后1小时进行系列肌钙蛋白检测以评估急性冠状动脉综合征（ACS）的可能性，已被纳入2015年欧洲指南。我们的目的是评估该方案在急诊科低风险患者日常实践中的安全性。
纳入因急性胸痛就诊于我院急诊科且年龄小于75岁的患者（2013年5月至2014年10月，荷兰）。在就诊时（T0）及T0后1 - 1.5小时（T1）检测hs-cTnT。首次肌钙蛋白（T0）≥0.012 μg/l的患者被排除。主要终点是6周内发生的主要不良心脏事件（MACE），定义为不稳定型心绞痛、急性心肌梗死（AMI）、经皮冠状动脉介入治疗、保守治疗的严重狭窄、冠状动脉旁路移植术和死亡。
在374例分析患者中，16例（4.3%）发生了35次MACE。在这16例有终点事件的患者中，3例最初因非心脏性胸痛出院，但在6周内因不稳定型心绞痛返回。重要的是，随访期间无患者发生AMI或死亡。
在胸痛患者中引入1小时hs-cTnT方案以排除ACS后，未发生AMI或死亡，但发生了不稳定型心绞痛等其他MACE。我们的结果表明该方案在荷兰急诊科实施是安全的。
