Seo Youngho, Paik Jinhui, Shin Seunglyul, Kim Ahjin, Kang Soo
Department of Emergency Medicine, Inha University College of Medicine, Incheon, Korea.
Department of Hospital Medicine, Inha University College of Medicine, Incheon, Korea.
Clin Exp Emerg Med. 2020 Sep;7(3):213-219. doi: 10.15441/ceem.19.049. Epub 2020 Sep 30.
Emergency physicians experience difficulty in determining the disposition of patients with elevated troponin I levels using emergency room tests. In this study, we aimed to investigate factors that could discriminate between the occurrence of type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI) in patients with elevated troponin I levels.
Patients admitted to the emergency department between January 1, 2017 and June 30, 2017 with elevated troponin I levels who underwent subsequent cardiac biomarker testing were included. Samples for baseline blood tests, such as cardiac biomarker levels, were collected within approximately 10 minutes of admission. Electrocardiogram, transthoracic echocardiography, and percutaneous coronary intervention results were retrospectively examined via patient report and chart reviews.
During the study period, 169 of 234 (72%) patients were diagnosed with T2MI and 65 (28%) were diagnosed with T1MI. Among various factors, typical chest pain (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.46 to 13.24; P=0.008), high troponin I levels (OR, 1.50; 95% CI, 1.19 to 1.90; P<0.001), high cholesterol (OR, 1.01; 95% CI, 1.00 to 1.02; P=0.008), and low D-dimer levels (OR, 0.87; 95% CI, 0.77 to 0.98; P=0.027) were significantly associated with T1MI incidence.
Our findings in this study indicate that typical chest pain, high levels of troponin I and cholesterol, and low levels of D-dimer were associated with the diagnosis of T1MI. Further studies are suggested to determine the cut-off values for accurate diagnosis of T1MI in the ED.
急诊医生在利用急诊室检查来确定肌钙蛋白I水平升高患者的处置方式时存在困难。在本研究中，我们旨在调查能够区分肌钙蛋白I水平升高患者发生1型心肌梗死（T1MI）和2型心肌梗死（T2MI）的因素。
纳入2017年1月1日至2017年6月30日期间因肌钙蛋白I水平升高而入住急诊科且随后接受心脏生物标志物检测的患者。在入院后约10分钟内采集用于基线血液检查的样本，如心脏生物标志物水平。通过患者报告和病历回顾对心电图、经胸超声心动图和经皮冠状动脉介入治疗结果进行回顾性检查。
在研究期间，234例患者中有169例（72%）被诊断为T2MI，65例（28%）被诊断为T1MI。在各种因素中，典型胸痛（比值比[OR]，4.40；95%置信区间[CI]，1.46至13.24；P = 0.008）、高肌钙蛋白I水平（OR，1.50；95% CI，1.19至1.90；P < 0.001）、高胆固醇（OR，1.01；95% CI，1.00至1.02；P = 0.008）和低D - 二聚体水平（OR，0.87；95% CI，0.77至0.98；P = 0.027）与T1MI发生率显著相关。
我们在本研究中的发现表明，典型胸痛、高肌钙蛋白I和胆固醇水平以及低D - 二聚体水平与T1MI的诊断相关。建议进一步开展研究以确定在急诊科准确诊断T1MI的临界值。
