College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia.
Department of Cardiology, University Hospitals of Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK; Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QF, UK.
Int J Cardiol. 2022 Jan 15;347:66-72. doi: 10.1016/j.ijcard.2021.11.013. Epub 2021 Nov 11.
Explore the impact of deploying high-sensitivity (hs) cardiac troponin T (cTnT) assay across a state-wide health service.
Presentations to emergency departments of six tertiary hospitals between January 2008 and August 2019 were included; standard cTnT assay was superseded by hs-cTnT in June 2011 without changing the reference range (≥30 ng/L reported as elevated), despite cTnT level of 30 ng/L being equivalent to ∼44 ng/L with hs-cTnT. Clinical outcomes were captured using state-wide linked health records. Interrupted time series analyses were used adjusted for seasonality and multiple co-morbidities using propensity score matching allowing for correlation within hospitals. In total, 614,847 presentations had ≥1 troponin measurement. Clinical ordering of troponin decreased throughout the study with no increase in elevated measurements amongst those tested with hs-cTnT. Small but statistically significant changes in index myocardial infarction (MI) diagnosis (-0.36%/year, 95%CI [confidence interval]:-0.48, -0.24,p < 0.001) and invasive coronary angiography (0.12%/year,95%CI:0, 0.24,p = 0.02) were seen, with no impact on death/MI at 30 days or 3-year survival in episodes of care (EOCs) with elevated cTnT after hs-cTnT implementation. Length of stay (LOS) was shorter among those with an elevated hs-cTnT (-4.44 h/year, 95%CI:-5.27, -3.60, p < 0.001). Non-elevated cTnT EOCs demonstrated shorter total LOS and improved 3-year survival (adjusted hazard ratio:0.90, 95%CI:0.83, 0.97,p = 0.008) although death/MI at 30 days was unchanged using hs-cTnT.
Widespread implementation of hs-cTnT without altering clinical thresholds reported to clinicians provided significantly shorter LOS without a clinically significant impact on clinical outcomes. A safer cohort with non-elevated cTnT was identified by hs-cTnT compared to the standard cTnT assay.
探讨在全州范围内医疗服务中部署高敏（hs）心肌肌钙蛋白 T（cTnT）检测的影响。
纳入 2008 年 1 月至 2019 年 8 月期间六所三级医院急诊科就诊的病例；2011 年 6 月，标准 cTnT 检测被 hs-cTnT 取代，而报告的临界值（≥30ng/L 为升高）并未改变，尽管 cTnT 水平为 30ng/L 与 hs-cTnT 水平相当，约为 44ng/L。使用全州范围内的关联健康记录来获取临床结局。使用倾向性评分匹配来调整季节性和多种合并症的影响，允许在医院内进行相关性分析。共有 614847 例至少有一次肌钙蛋白检测。在整个研究期间，肌钙蛋白的临床检测量逐渐减少，hs-cTnT 检测中升高的检测量并没有增加。指数心肌梗死（MI）诊断（-0.36%/年，95%CI：-0.48，-0.24，p<0.001）和经皮冠状动脉造影（0.12%/年，95%CI：0，0.24，p=0.02）略有但有统计学意义的变化，在 hs-cTnT 实施后升高的 cTnT 中，30 天或 3 年的死亡率/MI 或 EOC 生存率没有影响。hs-cTnT 升高的患者住院时间（LOS）缩短（-4.44 小时/年，95%CI：-5.27，-3.60，p<0.001）。非升高的 cTnT EOC 显示总 LOS 缩短和 3 年生存率提高（调整后的危险比：0.90，95%CI：0.83，0.97，p=0.008），尽管 30 天的死亡率/MI 没有变化。
不改变报告给临床医生的临界值而广泛应用 hs-cTnT，可显著缩短 LOS，对临床结局无明显影响。与标准 cTnT 检测相比，hs-cTnT 检测发现非升高的 cTnT 患者的安全性更高。
