Division of Hospital Internal Medicine, Mayo Clinic Health System, La Crosse, Wisconsin, USA; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy.
J Am Coll Cardiol. 2021 Jun 29;77(25):3160-3170. doi: 10.1016/j.jacc.2021.04.050. Epub 2021 May 3.
Limited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation.
This study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation.
Observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing.
In this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p < 0.0001). Acute MI (3.3% vs. 8.1%; p < 0.0001) and myocardial injury (11% vs. 38%; p < 0.0001) increased. Although type 1 MIs increased (1.7% vs. 2.9%; p = 0.0097), the overall MI increase was largely due to more type 2 MIs (1.6% vs. 5.2%; p < 0.0001). Women were less likely than men to have MI using 4th Gen cTnT (2.3% vs. 4.4%; p = 0.008) but not 5th Gen cTnT (7.7% vs. 8.5%; p = 0.46). Overall length of stay and stress testing were reduced, and angiography was increased (all p < 0.05). Among those without cTnT increases, there were more ED discharges and a reduction in length of stay, echocardiography, and stress tests (all p < 0.05).
High-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.
美国关于高敏心肌肌钙蛋白（cTn）应用的数据有限。
本研究旨在评估高敏心肌肌钙蛋白 T（cTnT）检测应用的影响。
这是一项在美国进行的观察性研究，纳入在急诊科接受 cTnT 检测的患者，检测时间在从第 4 代（前实施阶段 2018 年 3 月 12 日至 2018 年 9 月 11 日）过渡到第 5 代（后实施阶段 2018 年 9 月 12 日至 2019 年 3 月 11 日）cTnT 期间。采用第四版心肌梗死通用定义（MI）对诊断进行评估。评估的资源包括住院时间、住院和心脏检测。
这项研究共纳入了 3536 例患者，包括实施前后分别为 2069 例和 2491 例 ED 就诊。与第 4 代 cTnT 相比，第 5 代 cTnT 检测出更多的 cTnT>99 百分位（≥1 cTnT >99th percentile）（15% vs. 47%；p < 0.0001）。急性 MI（3.3% vs. 8.1%；p < 0.0001）和心肌损伤（11% vs. 38%；p < 0.0001）的发生率增加。虽然 1 型 MI 增加（1.7% vs. 2.9%；p = 0.0097），但 MI 总体增加主要是由于 2 型 MI 增加（1.6% vs. 5.2%；p < 0.0001）。与第 4 代 cTnT 相比，女性发生 MI 的可能性小于男性（2.3% vs. 4.4%；p = 0.008），但在第 5 代 cTnT 中无差异（7.7% vs. 8.5%；p = 0.46）。总体住院时间和应激试验减少，而血管造影增加（均 p < 0.05）。在 cTnT 无增加的患者中，ED 出院率更高，住院时间、超声心动图和应激试验减少（均 p < 0.05）。
高敏 cTnT 检测的应用导致心肌损伤和 MI 显著增加，尤其是在女性和 2 型 MI 患者中。尽管如此，除了血管造影外，总体资源使用并未增加。在 cTnT 无增加的患者中，ED 出院率更高，心脏检查减少。
