Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York; Cardiac Electrophysiology Section, Cleveland Clinic, Cleveland, Ohio.
Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York.
J Emerg Med. 2022 May;62(5):657-667. doi: 10.1016/j.jemermed.2022.01.011. Epub 2022 Apr 2.
The new high-sensitivity cardiac troponin T (hs-cTnT) is now widely used in the United States.
We aimed to examine outcomes associated with the introduction of the new 5 generation hs-cTnT assay among patients presenting to the emergency department (ED) with cardiovascular (CV) disorders.
The study comprised 5377 patients presenting to the ED with CV disorders between January and September 2018. Outcomes included rates of direct ED discharge, cardiac testing/procedures, and mortality. CV indications for troponin testing were categorized as rule-out acute coronary syndrome (RO-ACS) and other-CV (O-CV).
Mean age was 62 ± 17 years, and 47% were female. Demographics and medical history did not differ significantly between the troponin groups. The use of hs-cTnT was associated with increased rates of direct discharge from the ED in the RO-ACS (48% vs. 37%; p < 0.01), but not in the O-CV (25% vs. 25%) cohort. Cardiac tests/procedures were more often performed after hs-cTnT vs. cTnT testing in both cohorts (45% vs. 41% for RO-ACS, and 33% vs. 28% for O-CV; p < 0.05 for both). Multivariate analysis demonstrated that hs-cTnT was not associated with a significant increase in postdischarge mortality in both cohorts (RO-ACS: hazard ratio = 1.47 [p = 0.13], O-CV: hazard ratio = 0.97 [p = 0.87]).
Among patients with RO-ACS, hs-cTnT implementation resulted in increased rates of direct home discharge from the ED, without a significant increase in postdischarge mortality. Among patients presenting with O-CV indication, hs-cTnT implementation resulted in increased rates of cardiac testing procedures without an effect of ED discharge rates or long-term mortality.
新的高敏心肌肌钙蛋白 T（hs-cTnT）目前在美国广泛应用。
我们旨在研究新的第 5 代 hs-cTnT 检测方法在因心血管疾病就诊于急诊科（ED）的患者中应用的结果。
该研究纳入了 2018 年 1 月至 9 月间因心血管疾病就诊于 ED 的 5377 例患者。结果包括直接 ED 出院率、心脏检查/操作和死亡率。肌钙蛋白检查的心血管适应证分为排除急性冠状动脉综合征（RO-ACS）和其他心血管（O-CV）。
患者平均年龄为 62 ± 17 岁，47%为女性。两组的人口统计学和病史无显著差异。hs-cTnT 的使用与 RO-ACS 患者 ED 直接出院率的增加相关（48% vs. 37%；p < 0.01），但与 O-CV 患者无关（25% vs. 25%）。与 cTnT 检查相比，hs-cTnT 检查后更常进行心脏检查/操作（RO-ACS 组为 45% vs. 41%，O-CV 组为 33% vs. 28%；p < 0.05）。多变量分析表明，hs-cTnT 与两组患者出院后死亡率均无显著相关性（RO-ACS：危险比=1.47 [p=0.13]，O-CV：危险比=0.97 [p=0.87]）。
在 RO-ACS 患者中，hs-cTnT 的应用导致 ED 直接出院率增加，但出院后死亡率无显著增加。在因 O-CV 就诊的患者中，hs-cTnT 的应用导致心脏检查/操作的比例增加，但 ED 出院率和长期死亡率无变化。
