Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia.
Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia.
Eur Heart J Qual Care Clin Outcomes. 2020 Jan 1;6(1):41-48. doi: 10.1093/ehjqcco/qcz019.
As assessment of patients with suspected acute coronary syndromes (ACS) in emergency departments (EDs) represents a major workload because high-sensitivity troponin (HsTn) T and I levels are frequently measured, and a minority of patients have final diagnosis of myocardial infarction (MI). We determined the relative frequencies of three patients groups: Type-I MI, Type-II MI (including acute myocardial injury).
Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014. We studied the use of invasive and pharmacological therapies, and 4-year outcomes. Adjudication of MI was according to the 4th universal definition as follows: (i) Type-I MI; (ii) Type-II MI (including acute myocardial injury), and (iii) chronic myocardial injury. Of 995 patients (36%) [median age 76 years (interquartile range 65-83)] with ≥2 HsTnT measurements and one >14 ng/L, 727 (73%) had chronic myocardial injury, 171 (17%) had Type-II MI, and 97 (9.7%) had Type-I MI; respective late mortality rates to 48 months were 33%, 43%, and 14% (P < 0.001). In-hospital angiography rates were 95% for patients with Type-I MI, [62% had percutaneous coronary intervention (PCI)] 24% (7% PCI) for those with Type-II MI, and 3.4% for chronic myocardial injury. On Cox modelling for mortality relative to Type 1 MI, adjusted hazard ratios were 1.94 [95% confidence intervals (CIs) 1.06-3.57]; P = 0.032 for Type 2 MI, and for chronic myocardial injury 1.14 (95% CIs 0.64-2.02); P = 0.66.
Among unselected patients undergoing HsTnT testing in EDs, Type-II MI including acute myocardial injury was more common than Type-I MI. Chronic myocardial injury, which occurred in three of four patients. Whereas patients with Type-II MI had higher late mortality than those with Type-I MI, after multivariable analyses mortality rates were marginally different.
由于急诊部门（EDs）经常检测高敏肌钙蛋白（hsTn）T 和 I 水平，因此评估疑似急性冠状动脉综合征（ACS）的患者会带来很大的工作量，而且少数患者的最终诊断为心肌梗死（MI）。我们确定了三个患者群体的相对频率：I 型 MI、II 型 MI（包括急性心肌损伤）。
在 2014 年 3 月至 6 月期间，澳大利亚利物浦医院的 2738 名连续疑似 ACS 的患者中，我们研究了侵袭性和药物治疗的应用以及 4 年的结果。MI 的判定根据第 4 次通用定义如下：（i）I 型 MI；（ii）II 型 MI（包括急性心肌损伤），和（iii）慢性心肌损伤。在 995 名（36%）[中位数年龄 76 岁（四分位间距 65-83）]至少有 2 次 hsTnT 测量值和一次大于 14ng/L 的患者中，727 名（73%）有慢性心肌损伤，171 名（17%）有 II 型 MI，97 名（9.7%）有 I 型 MI；分别在 48 个月的晚期死亡率为 33%、43%和 14%（P<0.001）。I 型 MI 患者的住院期间血管造影率为 95%[62%接受经皮冠状动脉介入治疗（PCI）]，II 型 MI 患者为 24%（7% PCI），慢性心肌损伤患者为 3.4%。对死亡率与 I 型 MI 相关的 Cox 模型进行校正后，风险比分别为 1.94[95%置信区间（CI）1.06-3.57]；P=0.032 为 II 型 MI，慢性心肌损伤为 1.14（95%CI 0.64-2.02）；P=0.66。
在接受 EDs 中 hsTnT 检测的未选择患者中，包括急性心肌损伤的 II 型 MI 比 I 型 MI 更常见。慢性心肌损伤在四分之三的患者中发生。尽管 II 型 MI 患者的晚期死亡率高于 I 型 MI 患者，但在多变量分析后，死亡率略有不同。
