Faculty of Medicine, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada.
The Ottawa Hospital Research Institute, Ottawa, Canada.
Australas Emerg Care. 2022 Mar;25(1):37-40. doi: 10.1016/j.auec.2021.04.004. Epub 2021 May 6.
The Ottawa Troponin Pathway (OTP) was developed to improve Non-ST elevation myocardial infarction (NSTEMI) diagnosis accuracy using 3-h serial conventional troponin I (TnI) measurements. We sought to validate the OTP in patients with TnI values >99th percentile upper reference limit (>45 ng/L).
We conducted a health records review in adult patients with NSTEMI symptoms with at least two serial TnI and at least one >45 ng/L at two emergency departments (EDs). We collected baseline characteristics, ED management and disposition. 30-day outcomes included death due to cardiac ischemia, an unknown cause, or NSTEMI.
635 patients were included, and 107 patients were diagnosed with NSTEMI within 30-days. 217 patients had at least one TnI value >45 ng/L but <100 ng/L, of whom 4 patients were diagnosed with NSTEMI. 418 patients had at least one TnI value ≥100 ng/L, and 103 were diagnosed with NSTEMI. The OTP accurately identified all 107 patients with NSTEMI: sensitivity and specificity was 100% (95% CI 96.6%-100%) and 32.2% (95% CI 28.2%-36.4) respectively.
The OTP is validated among patients with TnI values above the 99th percentile with symptoms concerning for ACS. Using OTP will allow for early referral and discharge home and improve ED crowding.
20180393-01H.
渥太华肌钙蛋白路径（OTP）的开发是为了提高非 ST 段抬高型心肌梗死（NSTEMI）的诊断准确性，使用 3 小时连续常规肌钙蛋白 I（TnI）测量。我们试图在 TnI 值>第 99 百分位上限（>45ng/L）的患者中验证 OTP。
我们对两家急诊科（EDs）至少有两次连续 TnI 且至少有一次>45ng/L 的有 NSTEMI 症状的成年患者进行了病历回顾。我们收集了基线特征、ED 管理和处置情况。30 天的结局包括因心脏缺血、未知原因或 NSTEMI 导致的死亡。
共纳入 635 例患者，其中 107 例在 30 天内诊断为 NSTEMI。217 例患者至少有一次 TnI 值>45ng/L 但<100ng/L，其中 4 例被诊断为 NSTEMI。418 例患者至少有一次 TnI 值≥100ng/L，其中 103 例被诊断为 NSTEMI。OTP 准确地识别出所有 107 例 NSTEMI 患者：敏感性和特异性分别为 100%（95%CI 96.6%-100%）和 32.2%（95%CI 28.2%-36.4%）。
OTP 在 TnI 值高于第 99 百分位且有 ACS 相关症状的患者中得到验证。使用 OTP 将允许早期转介和出院回家，并改善 ED 拥挤。
REB 编号：20180393-01H。
