Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Intern Emerg Med. 2022 Apr;17(3):655-663. doi: 10.1007/s11739-021-02668-1. Epub 2021 Feb 26.
Intermediate zone troponin elevation is defined as one to five times the upper limit of normal. Approximately half the patients presenting with chest pain to the emergency department have initial intermediate zone troponin.
We aimed to investigate the long-term outcome of patients hospitalized with chest pain and intermediate zone troponin elevation.
We investigated 8269 patients hospitalized in a tertiary center with chest pain. All patients had serial measurements of troponin during hospitalization. Patients were divided into three groups based on their initial troponin levels: negative troponin (N = 6112), intermediate zone troponin (N = 1329) and positive troponin (N = 828). All patients underwent myocardial perfusion imaging (MPI) as part of the initial evaluation.
Mean age of the study population was 68 ± 11, of whom 36% were women. Patients with an intermediate zone troponin were older, more likely to be males, and with significantly more cardiovascular co-morbidities. Multivariate analysis adjusted for age, gender, cardiovascular risk factors, and abnormal MPI result found that patients with intermediate zone troponin had a 70% increased risk of re-hospitalization at 1 year (HR 1.70, 95%CI 1.48-1.96, p-value < 0.001) and 5.3 times higher risk of total mortality at 1-year (HR 5.33, 95%CI 3.65-7.78, p-value < 0.001). sub-group analysis found that among the intermediate zone troponin group, patients with double intermediate zone troponin had the poorest outcome.
Intermediate zone troponin elevation is an independent risk factor associated with adverse outcomes and therefore patients with an initial value in this range should be closely monitored and aggressively managed.
中间区肌钙蛋白升高定义为正常值的 1 至 5 倍。大约一半因胸痛到急诊科就诊的患者最初有中间区肌钙蛋白升高。
我们旨在研究因胸痛和中间区肌钙蛋白升高住院的患者的长期预后。
我们调查了一家三级中心因胸痛住院的 8269 例患者。所有患者在住院期间均进行了连续肌钙蛋白测量。根据初始肌钙蛋白水平，患者分为三组：阴性肌钙蛋白组（N=6112）、中间区肌钙蛋白组（N=1329）和阳性肌钙蛋白组（N=828）。所有患者均接受心肌灌注成像（MPI）作为初始评估的一部分。
研究人群的平均年龄为 68±11 岁，其中 36%为女性。中间区肌钙蛋白组患者年龄较大，更可能为男性，且伴有明显更多的心血管合并症。多变量分析调整年龄、性别、心血管危险因素和异常 MPI 结果后发现，中间区肌钙蛋白组患者在 1 年时再住院的风险增加 70%（HR 1.70，95%CI 1.48-1.96，p 值<0.001），1 年时总死亡率的风险增加 5.3 倍（HR 5.33，95%CI 3.65-7.78，p 值<0.001）。亚组分析发现，在中间区肌钙蛋白组中，双中间区肌钙蛋白升高的患者预后最差。
中间区肌钙蛋白升高是不良预后的独立危险因素，因此初始值在此范围内的患者应密切监测并积极管理。
