Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-Do, Republic of Korea.
Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Gyeongsangnam-Do, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Gyeongsangnam-Do, Republic of Korea.
Am J Emerg Med. 2019 Jun;37(6):1013-1019. doi: 10.1016/j.ajem.2018.08.035. Epub 2018 Aug 15.
It is difficult to differentiate whether coronary or non-coronary causes in patients with elevated troponin I (TnI) in emergency department (ED). The aim of this study was to develop a clinical decision tool for differentiating a coronary cause in the patients with elevated TnI.
This was a retrospective observational study that enrolled consecutive ED patients. Patients were included in the study if they were ≥16 years of age, had admitted through ED with a medical illness, and TnI levels at initial evaluation in the ED were ≥0.2 ng/mL. Patients diagnosed with ST elevation myocardial infarction or congestive heart failure were excluded. Coronary angiography, electrocardiogram, laboratory results, echocardiography, and clinical characteristics were analyzed.
Among the included 1441 patients, 603 and 838 patients were categorized into an acute coronary syndrome (ACS) group and non-acute coronary syndrome (non-ACS) group, respectively. The ratio of N-terminal pro-Btype natriuretic peptide (NT-proBNP) to TnI was significantly higher in the non-ACS group compared to the ACS group. The AUC of NT-proBNP/TnI (0.805, 95% CI, 0.784-0.826) was significantly superior to that of NT-proBNP/creatinine kinase-MB, TnI, and NT-proBNP. The patients of the non-ACS group with high levels of TnI and BNP showed more critically ill manifestation at the time of presentation and higher mortality.
NT-proBNP/TnI may help to distinguish medical patients with elevated TnI whether the elevated TnIs were caused from ACSs or from conditions other than ACS.
在急诊科（ED）中，肌钙蛋白 I（TnI）升高的患者，很难区分其病因是冠状动脉还是非冠状动脉。本研究旨在开发一种临床决策工具，以区分 TnI 升高患者的冠状动脉病因。
这是一项回顾性观察性研究，纳入了连续的 ED 患者。如果患者年龄≥16 岁，因内科疾病经 ED 入院，且 ED 初始评估时 TnI 水平≥0.2ng/mL，则将其纳入研究。排除 ST 段抬高型心肌梗死或充血性心力衰竭患者。分析冠状动脉造影、心电图、实验室结果、超声心动图和临床特征。
在纳入的 1441 例患者中，603 例和 838 例分别归入急性冠状动脉综合征（ACS）组和非急性冠状动脉综合征（非 ACS）组。与 ACS 组相比，非 ACS 组的 N 端脑利钠肽前体（NT-proBNP）/TnI 比值明显更高。NT-proBNP/TnI（0.805，95%CI，0.784-0.826）的 AUC 明显优于 NT-proBNP/肌酸激酶同工酶 MB、TnI 和 NT-proBNP。TnI 和 BNP 水平升高的非 ACS 组患者在就诊时表现出更严重的疾病表现，死亡率更高。
NT-proBNP/TnI 可能有助于区分 TnI 升高的内科患者，确定 TnI 升高是由 ACS 还是 ACS 以外的情况引起的。
