Kavsak Peter A, Cerasuolo Joshua O, Ko Dennis T, Ma Jinhui, Sherbino Jonathan, Mondoux Shawn E, Perez Richard, Seow Hsien, Worster Andrew
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
ICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
CJC Open. 2020 Mar 20;2(4):296-302. doi: 10.1016/j.cjco.2020.03.004. eCollection 2020 Jul.
For patients investigated for suspected acute coronary syndrome, there is uncertainty if a single measurement of high-sensitivity cardiac troponin I (hs-cTnI) at emergency department (ED) presentation can identify patients at both low and high risk for mortality.
We included consecutive adult patients in the ED who had a Clinical Chemistry Score (CCS) taken at presentation (ie, combination of glucose, creatinine for estimated glomerular filtration rate determination, and hs-cTnI assay) in a Canadian city between 2012 and 2013. Outcomes were 3-month, 1-year, and 5-year all-cause mortality using the provincial death registry. Mortality rates and test performance (eg, sensitivity and specificity) with 95% confidence intervals (CIs) were obtained for the CCS or hs-cTnI assay alone using established cutoffs for these tests.
Our cohort included 5974 patients with a 1-year mortality rate of 17.2% (95% CI, 16.2-18.3). A CCS ≥ 1 yielded a sensitivity of 99.2% (95% CI, 98.4-99.6) compared with the hs-cTnI ≥ 5 ng/L cutoff sensitivity of 88.4% (95% CI, 86.3-90.3), with the mortality rate being significantly lower for patients with CCS < 1 (2.0%; 95% CI, 0.9-4.0) vs patients with hs-cTnI < 5 ng/L (5.0%; 95% CI, 4.2-6.0) at 1 year ( 0.01). A CCS of 5 also yielded a higher specificity (88.5%; 95% CI, 87.5-89.3) compared with hs-cTnI > 26 ng/L (83.9%; 95% CI, 82.9-84.9), with no difference in mortality rates (37.4% vs 36.3%; 0.66). This trend was consistent at 3-month and 5-year mortality.
For patients in the ED with a potential cardiac issue, using the CCS cutoffs can better identify patients at low and high risk for mortality than using published cutoffs for hs-cTnI alone.
对于因疑似急性冠状动脉综合征而接受检查的患者，在急诊科（ED）就诊时单次测量高敏心肌肌钙蛋白I（hs-cTnI）能否识别出死亡风险低和高的患者尚不确定。
我们纳入了2012年至2013年期间在加拿大一个城市的急诊科连续就诊的成年患者，这些患者在就诊时进行了临床化学评分（CCS）（即葡萄糖、用于估算肾小球滤过率的肌酐和hs-cTnI检测的组合）。使用省级死亡登记处的数据，观察指标为3个月、1年和5年的全因死亡率。使用这些检测的既定临界值，单独获得CCS或hs-cTnI检测的死亡率和检测性能（如敏感性和特异性）以及95%置信区间（CI）。
我们的队列包括5974例患者，1年死亡率为17.2%（95%CI，16.2 - 18.3）。CCS≥1时的敏感性为99.2%（95%CI，98.4 - 99.6），而hs-cTnI≥5 ng/L临界值的敏感性为88.4%（95%CI，86.3 - 90.3），1年时CCS<1的患者死亡率（2.0%；95%CI，0.9 - 4.0）显著低于hs-cTnI<5 ng/L的患者（5.0%；95%CI，4.2 - 6.0）（P = 0.01）。与hs-cTnI>26 ng/L（83.9%；95%CI，82.9 - 84.9）相比，CCS为5时也具有更高的特异性（88.5%；95%CI，87.5 - 89.3），死亡率无差异（37.4%对36.3%；P = 0.6）。在3个月和5年死亡率时这一趋势一致。
对于急诊科有潜在心脏问题的患者，使用CCS临界值比仅使用已公布的hs-cTnI临界值能更好地识别死亡风险低和高的患者。
