Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Emergency, Liverpool Hospital, Sydney, NSW, Australia.
College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, North Tce, SA, Australia.
Am J Med. 2021 Aug;134(8):1019-1028.e1. doi: 10.1016/j.amjmed.2021.03.005. Epub 2021 Apr 2.
With increasing age, patients with suspected acute coronary syndromes (ACS) and elevated high-sensitivity troponin T (HsTnT) levels, type-1 myocardial infarction (MI) is diagnosed less often, though associations among these factors, gender, and prognosis is unclear.
Patients presenting to the emergency department (ED) with potential ACS who underwent HsTnT testing were prospectively identified and followed. Diagnoses were adjudicated according to the Fourth Universal Definition of MI as follows: type-1 MI, type-2 MI, acute myocardial injury, chronic myocardial injury, and other diagnoses. Age in years was categorized: younger (<65); elderly (65-79), and very elderly (≥80).
Among 2738 patients with HsTnT measurements, 1611 were suitable for adjudication (42% ages 65 years and younger). Type-2 MI and chronic myocardial injury diagnoses were more common in those ages 65 years and older, whereas younger patients had more type-1 MI diagnoses. Late mortality rates at median 41 months (interquartile range [IQR] 10-57) were 44% (223 out of 506) in those ages 80 years and older, 22% (92 out of 423) in patients 65-79 years, and 7% (46 out of 682) in those 65 years and younger, irrespective of adjudicated diagnoses, log rank P ≤ .001. On multivariable analyses, the adjusted mortality hazard ratios for increasing HsTnT levels irrespective of diagnoses were attenuated in those age 80 years and older compared to younger patients.
Patients ages 65 years and older constituted ~60% of ED attendances of patients with suspected ACS, and more had type 2 MI and chronic myocardial injury diagnoses compared to younger patients. The relative mortality impact of HsTnT levels was lower among elderly patients irrespective of adjudicated diagnoses.
随着年龄的增长，在疑似急性冠状动脉综合征（ACS）和高敏肌钙蛋白 T（HsTnT）水平升高的患者中，1 型心肌梗死（MI）的诊断较少，但这些因素、性别和预后之间的关系尚不清楚。
前瞻性地确定并随访了因疑似 ACS 就诊于急诊科（ED）并接受 HsTnT 检测的患者。根据第四版 MI 的通用定义对诊断进行了判定：1 型 MI、2 型 MI、急性心肌损伤、慢性心肌损伤和其他诊断。年龄分为：年轻（<65 岁）；老年（65-79 岁）和非常老年（≥80 岁）。
在 2738 例接受 HsTnT 测量的患者中，1611 例适合判定（42%年龄在 65 岁以下）。年龄在 65 岁及以上的患者中，2 型 MI 和慢性心肌损伤的诊断更为常见，而年轻患者中 1 型 MI 的诊断更多。在中位时间为 41 个月（四分位距 [IQR] 10-57）的随访中，80 岁及以上患者的晚期死亡率为 44%（223 例中有 223 例），65-79 岁患者为 22%（92 例中有 92 例），65 岁及以下患者为 7%（682 例中有 46 例），无论诊断如何，对数秩检验 P≤.001。多变量分析显示，与年轻患者相比，80 岁及以上患者的 HsTnT 水平与调整后的死亡率之间的相关性减弱，而与诊断无关。
65 岁及以上的患者占疑似 ACS 患者 ED 就诊的~60%，与年轻患者相比，2 型 MI 和慢性心肌损伤的诊断更为常见。无论诊断如何，老年患者的 HsTnT 水平对死亡率的相对影响较低。
